A load sharing principle in abdominal wall reconstruction follow-up & case report: Strattice biologic mesh without the presence of adhesions

Abstract

Background: The senior authors previously published a paper on abdominal wall reconstruction using Strattice acellular dermal matrix demonstrating effective aesthetic and functional results. Despite the common and effective use of Strattice acellular dermal matrix for abdominal wall reconstruction, insurance companies do not universally approve its usage. Critics of its usage state that its intra-abdominal effects are unknown. Purpose: To further demonstrate that Strattice acellular dermal matrix is a safe and durable method to reconstruct the abdominal wall with maximal outcomes, minimal intra-abdominal morbidity, and adhesion formation. Methods: A retrospective chart review was done on our patient who underwent abdominal wall reconstruction of a ventral hernia with component separation and placement of Strattice acellular dermal matrix several years prior. The patient happened to develop appendicitis several years post abdominal wall reconstruction, requiring laparoscopic appendectomy. Photographic analysis was used to document the Strattice and absence of adhesions. Results: Strattice acellular dermal matrix was successfully used in the underlay intra-abdominal position to reinforce a midline hernia repair and external oblique component separation. At three years post hernia repair, the patient had no evidence of hernia. CT-scan demonstrated well opposed rectus abdominus muscles. On laparoscopic examination of the intraperitoneal cavity during appendectomy, there was no evidence of bowel adhesions to the abdominal wall or Strattice acellular dermal matrix. The Strattice was lined with peritoneum. Conclusion: Successful repair of primary and recurrent abdominal hernia with Strattice acellular dermal matrix is effective. In our experience, the production of adhesions between the bowl and the intraperitoneal placed Strattice is low.