Acellular Dermal Matrices in Abdominal Wall Reconstruction

Abstract

Introduction: Complex abdominal wall defects with contamination or loss of domain pose challenges. This review examines outcomes of acellular dermal matrix use in bridging or reinforcement.

Methods: A systematic review of studies reporting bridged or reinforced abdominal wall reconstruction with ADM. Inclusion: defects >10 cm width, contaminated fields, or recurrent hernias. Outcomes: hernia recurrence, infection, and seroma.

Results: Forty-one studies (n=1,823 patients) were included. Hernia recurrence at one year was 15% for ADM bridging versus 8% for reinforcement. Infection rates were 18% in contaminated fields, with ADM salvage successful in 70%. Seroma occurred in 12%. Component separation plus ADM reinforcement gave the lowest recurrence (6%). Recurrence increased over time.

Discussion: ADM is useful in contaminated settings where synthetic mesh is contraindicated. Bridging alone has higher failure rates. Reinforcement over component separation is preferred. Long-term data show gradual degradation of some ADM products.

Conclusions: ADM is effective in complex abdominal wall reconstruction, particularly in contaminated fields. Reinforcement rather than bridging is recommended when possible.