Abdominal wall reconstruction with dual layer cross-linked porcine dermal xenograft: The “Pork Sandwich” herniorraphy

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2012-03, Vol.65 (3), p.333-341
• Main Authors: Satterwhite, Thomas S, Miri, Sara, Chung, Christina, Spain, David A, Lorenz, Hermann P, Lee, Gordon K
• Format: Article
• Language: English
• Subjects: Abdominal wall; Adult; Aged; Biocompatible Materials; Biological and medical sciences; Body Mass Index; Collagen; Component separation; Fasciotomy; Female; Follow-Up Studies; Hernia, Ventral - surgery; Herniorrhaphy - methods; Humans; Male; Medical sciences; Middle Aged; Plastic Surgery; Porcine xenograft; Prospective Studies; Skin Transplantation - methods; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical Mesh; Transplantation, Heterologous; Treatment Outcome; Ventral hernia repair
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2011.09.044

Summary Introduction The repair of large ventral hernias is a challenging problem. This study investigated the use of decellularized, chemically cross-linked porcine dermal xenograft in conjunction with component separation (a.k.a. the “Pork Sandwich” Herniorraphy) in the repair of abdominal wall defects. Materials and methods We prospectively collected data over a 3-year period. Primary or near-total primary fascial closure was our goal in operative repair. A cross-linked porcine dermal xenograft mesh underlay and overlay were used to provide maximal reinforcement of the repair. Outcomes were compared with a case-controlled cohort of 84 patients who underwent ventral hernia repairs with alternative methods at our institution. Results Nineteen patients were included. Mean age was 55 years old, and mean body mass index (BMI) was 30 kg/m2 . Mean defect size was 321 cm2 . Post-operative complications were observed in ten out of 19 patients. Complications included seroma ( n  = 2), wound infection ( n  = 2), abscess ( n  = 1), skin necrosis ( n  = 6), and fistula formation ( n  = 3). Seven patients required re-operation. Statistically significant factors ( p  2 weeks), and a defect size greater than 300 cm2 . There were no hernia recurrences in our “Pork Sandwich” group, which contrasted favorably to the retrospective case-control group in which the hernia recurrence rate was 19% ( p  = 0.038). Discussion For the repair of abdominal hernias, primary closure, with component separation as needed, with an underlay and overlay of cross-liked porcine xenograft should be considered to minimize risk of recurrent herniation. Additional long-term prospective comparative studies are needed for further validation of the optimal method and material for repair.