Reconstruction of complex abdominal wall hernias using acellular human dermal matrix: a single institution experience

Background: Acellular human dermal matrix (AHDM) has mechanical properties suitable for complex abdominal wall reconstructions and physiologic properties that allow more resistance to infection in contaminated fields. The purpose of this study was to determine which patient and technical factors lead to optimal surgical outcomes. Methods: A retrospective review was conducted of 144 abdominal wall reconstructions using AHDM over a 33-month period. Data were recorded and analyzed. Results: Fifty-three percent were women. The average age was 55 years, with an average body mass index of 35 kg/m². Thirty percent were smokers at the time of repair, and 24% had diabetes. Forty-three percent of the operative fields had some degree of contamination. The indication for operation in half the patients was to reconstruct a previously failed hernia repair. The recurrence rate was 27.1%. The significant factors that affected the recurrence rate were female gender (P = .02), reconstructing a failed prior repair (P = .025), and high body mass index (P = .004). An underlay mesh placement trended to a lower recurrence rate (P = .053). Average follow-up time was 23 weeks (range, 0-100 weeks). Conclusions: Three patient factors contributed significantly to the recurrence rate in this study: gender, above-normal body mass index, and repairing a recurrent hernia. Placing the matrix as an underlay appears to decrease recurrence rates. Long-term follow-up is needed to further determine the durability of hernia repairs with AHDM. AHDM offers a viable option with acceptable morbidity in complex abdominal wall reconstructions in high-risk patient populations.