Single-stage abdominal wall reconstruction in contaminated and dirty wounds is safe: a single center experience

Abstract

Background: The proper approach to repair of complex abdominal wall hernia in contaminated and dirty surgical fields is unknown. Identification of a surgical approach limiting the number of operative procedures, post-operative complications, and financial burden is needed. We hypothesized that single-stage abdominal wall reconstruction using poly-4-hydroxybutyrate resorbable mesh would result in low incidence of post-operative surgical site occurrence and a low incidence of hernia recurrence in Centers for Disease Control class III and IV wounds.

Study design: We conducted a single institution, retrospective cohort study of consecutive patients, age greater than 18 years old, that underwent abdominal wall reconstruction complicated by presence of Centers for Disease Control class III and IV wounds between January 2014 and March 2019. Primary outcomes assessed were surgical site occurrence, hernia recurrence, and mesh-related adverse events.

Results: Thirty-four patients that underwent single-stage abdominal wall reconstruction utilizing poly-4-hydroxybutyrate mesh with contaminated (n = 12) and dirty/infected wounds (n = 22) were identified. Patients mean age was 64 years, and body mass index was 31 kg/m². Mean follow-up was 37 months, range of 21-60. Concurrent procedures included fistula takedown (n = 9), infected mesh removal (n = 6), and parastomal hernia repair (n = 6). Mean defect size was 150.7 cm². Surgical site occurrence rate was 12%, with 1 superficial and 2 deep surgical site infections. Midline hernia recurrence rate was 0, there were two parastomal hernia recurrences, for an overall hernia recurrence rate of 6%. No mesh-related adverse events occurred.

Conclusion: This study suggests that over a 3-year follow-up period single-stage complex abdominal wall reconstruction with poly-4-hydroxybutyrate is safe and durable. Single-stage complex abdominal wall reconstruction with poly-4-hydroxybutyrate mesh in the setting of Centers for Disease Control class III and IV wounds is a realistic option with acceptable outcomes.

Keywords: Abdominal wall reconstruction; Biosynthetic meshes; Complex ventral hernias; Component separation; Contaminated surgical field; Long-term follow-up.