Repair of Recurrent Ventral Hernias Using Tissue Expansion and Porcine Acellular Dermal Matrix
Authors: David M. Tauber & Alain Polynice
Recurrent ventral hernias are often large and associated with loss of abdominal domain, hindering primary closure. One established intervention for patients with large ventral hernias is the component separation procedure that advances muscle from the lateral abdomen. This technique allows closure without creating tension; however, the relaxing incisions weaken the lateral abdominal wall by altering its natural architecture. We propose an approach to primary midline closure that does not compromise lateral abdominal wall stability and restores the architecture of the abdominal wall while allowing tension-free midline closure.
This case series demonstrates that a stable abdominal wall can be achieved in patients with complex ventral hernias who have undergone repeated repair surgeries for multiple recurrences. In these patients, more conservative methods have failed.
Expansion of the abdominal wall helped establish a tension-free repair by restoring lost domain. This repair was reinforced with an underlay and overlay of PADM to further offload the midline closure and distribute tension laterally. Successful results were achieved without devascularizing the abdominal skin or weakening the abdominal wall, as is typically observed with the standard component separation technique.
We are excited by our initial results in the limited number of patients included in this study. More cases are required, however, to confirm our results and further follow-up of our current patients is required to assess the long-term stability of the closure.
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