Acellular Dermal Matrix Research Articles

Staged Mastopexy before Nipple-Sparing Mastectomy: Improving Safety and Appearance in Breast Reconstruction.

Breast reconstruction following nipple-sparing mastectomy (NSM) in patients with large or ptotic breasts remains challenging because of the risk of ischemic complications and the difficulty in managing the redundant skin envelope. Staged mastopexy or breast reduction before the mastectomy/reconstruction has been shown to decrease the risk of complications and improve clinical outcomes. A retrospective analysis was conducted of patients with a genetic predisposition to breast cancer who underwent staged breast reduction/mastopexy before NSM and reconstruction in the authors' institution. In patients with in situ disease or invasive cancer, the first stage consisted of lumpectomy and oncoplastic reduction/mastopexy. Breast reconstruction at the second stage was performed with free abdominal flaps or breast implants and acellular dermal matrix. Data regarding the ischemic complications were recorded. In total, 47 patients (84 breasts) underwent this staged approach. All patients had a genetic predisposition to breast cancer. The time interval between the two stages was 11.5 months (range, 1.3 to 23.6 months). Twelve breasts (14.3%) were reconstructed with free abdominal flaps, six (7.1%) with tissue expanders, and 66 (78.6%) with permanent subpectoral implants and acellular dermal matrix. There was one case of postoperative superficial nipple-areola complex epidermolysis (1.2%), and two cases of partial mastectomy skin flap necrosis (2.4%). The mean follow-up time after completion of reconstruction was 8.3 months. Mastopexy or breast reduction before NSM and reconstruction is a safe procedure with a low risk of ischemic complications. Therapeutic, IV.

Prevention of Post Traumatic Radioulnar Heterotopic Ossification Recurrence Using Acellular Human Dermal Matrix: A Case Report and Review of Literature

Prevention of Post Traumatic Radioulnar Heterotopic Ossification Recurrence Using Acellular Human Dermal Matrix: A Case Report and Review of Literature

Attenuating Chronic Fibrosis: Decreasing Foreign Body Response with Acellular Dermal Matrix.

Surgical implants are increasingly used across multiple medical disciplines, with applications ranging from tissue reconstruction to improving compromised organ and limb function. Despite their significant potential for improving health and quality of life, biomaterial implant function is severely limited by the body's immune response to its presence: this is known as the foreign body response (FBR) and is characterized by chronic inflammation and fibrotic capsule formation. This response can result in life-threatening sequelae such as implant malfunction, superimposed infection, and associated vessel thrombosis, in addition to soft tissue disfigurement. Patients may require frequent medical visits, as well as repeated invasive procedures, increasing the burden on an already strained health care system. Currently, the FBR and the cells and molecular mechanisms that mediate it are poorly understood. With applications across a wide array of surgical specialties, acellular dermal matrix (ADM) has emerged as a potential solution to the fibrotic reaction seen with FBR. Although the mechanisms by which ADM decreases chronic fibrosis remain to be clearly characterized, animal studies across diverse surgical models point to its biomimetic properties that facilitate decreased periprosthetic inflammation and improved host cell incorporation. Impact Statement Foreign body response (FBR) is a significant limitation to the use of implantable biomaterials. Acellular dermal matrix (ADM) has been observed to decrease the fibrotic reaction seen with FBR, although its mechanistic details are poorly understood. This review is dedicated to summarizing the primary literature on the biology of FBR in the context of ADM use, using surgical models in breast reconstruction, abdominal and chest wall repair, and pelvic reconstruction. This article will provide readers with an overarching review of shared mechanisms for ADM across multiple surgical models and diverse anatomical applications.

Early Complications after Prepectoral Tissue Expander Placement in Breast Reconstruction with and without Acellular Dermal Matrix.

Prepectoral breast reconstruction has become popularized with the concurrent use of acellular dermal matrix (ADM). The authors sought to compare 3-month postoperative complication rates and explantation rates for first-stage, tissue-expander-based, prepectoral breast reconstruction with and without the use of ADM. A single-institution retrospective chart review was performed to identify consecutive patients undergoing prepectoral tissue-expander-based breast reconstruction from August of 2020 to January of 2022. Chi-square tests were used to compare demographic categorical variables, and multiple variable regression models were used to identify variables associated with 3-month postoperative outcomes. The authors enrolled 124 consecutive patients. Fifty-five patients (98 breasts) were included in the no-ADM cohort and 69 patients (98 breasts) were included in the ADM cohort. There were no statistically significant differences between the ADM and no-ADM cohorts with regard to 90-day postoperative outcomes. On multivariable analysis, there were no independent associations between seroma, hematoma, wound dehiscence, mastectomy skin flap necrosis, infection, unplanned return to the operating room, or explantation in the ADM and no-ADM groups after controlling for age, body mass index, history of diabetes, tobacco use, neoadjuvant chemotherapy, and postoperative radiotherapy. The authors' results reveal no significant differences in odds of postoperative complications, unplanned return to the operating room, or explantation between the ADM and no-ADM cohorts. More studies are needed to evaluate the safety of prepectoral, tissue expander placement without ADM. Therapeutic, III.

Component Separation Decreases Hernia Recurrence Rates in Abdominal Wall Reconstruction with Biologic Mesh.

It is not clear whether mesh-reinforced anterior component separation (CS) for abdominal wall reconstruction (AWR) results in better outcomes than mesh-reinforced primary fascial closure (PFC) without CS, particularly when acellular dermal matrix is used. The authors compared outcomes of CS versus PFC repair in AWR procedures aiming to determine whether CS results in better outcomes. This retrospective study of prospectively collected data included 461 patients who underwent AWR with acellular dermal matrix during a 10-year period at an academic cancer center. The primary endpoint was hernia recurrence; the secondary outcome was surgical-site occurrence (SSO). A total of 322 patients (69.9%) who underwent mesh-reinforced AWR with CS (AWR-CS) and 139 (30.1%) who underwent AWR with PFC (AWR-PFC) without CS were compared. AWR-PFC repairs had a higher hernia recurrence rate than AWR-CS repairs (10.8% versus 5.3%; P = 0.002) but similar overall complication (28.8% versus 31.4%; P = 0.580) and SSO (18.7% versus 25.2%; P = 0.132) rates. CS repairs experienced significantly higher wound separation (17.7% versus 7.9%; P = 0.007), fat necrosis (8.7% versus 2.9%; P = 0.027), and seroma (5.6% versus 1.4%; P = 0.047) rates than PFC repairs. The best cutoff with respect to hernia recurrence was 7.1 cm of abdominal defect width. AWR-CS repair resulted in a lower hernia recurrence rate than AWR-PFC but, despite the additional surgery, had similar SSO rates on long-term follow-up. Therapeutic, III.

Cultivation and cryopreservation of rat stem cells and their interaction with lyophilised acellular matrix

With the rapid development of regenerative medicine in the 21st century, the study of the therapeutic potential of stem cells in both preclinical research and clinical trials has become particularly relevant. Preclinical studies on animals allow for a detailed understanding of the mechanisms of action of allogzeneic cell preparations, exploring their regenerative activity, pharmacodynamics, and potential side effects. The purpose of the study was to select optimal conditions for obtaining, cultivating, and cryopreserving mesenchymal stem cells from rats and analyse their interaction with the lyophilised acellular matrix. The enzymatic method was applied to obtain primary cell cultures from the umbilical cord, dermis, and muscles of Rattus norvegicus fetuses. Cell cultures were cultivated in vitro, and cell line proliferation rates were analysed using an inverted microscope. In addition, cryopreservation was performed to store cellular materials. The interaction of mesenchymal stem cells with an acellular matrix and cryopreservation of the obtained cells was at the 4 and 5th passages. It was shown that the optimal nutrient medium for cultivating the obtained lines of mesenchymal stem cells from the umbilical cord and dermis of rat fetuses is DMEM/F12 Advanced. It was established that the method of thawing the cell suspension by 10-fold dilution of dimethyl sulfoxide is more effective than the alternative method of immediate removal of cryoprotectant by centrifugation. The lyophilised acellular dermal matrix was found to have a cytotoxic effect on all cultured rat cells, while the pericardial matrix showed a positive effect on the growth of the investigated cell lines. Thus, the optimal nutrient medium and conditions for freezing/thawing of rat stem cells were selected, and the effect of lyophilised acellular matrix, planned for therapeutic use, on the obtained cell lines was determined

Glans Adipodermal Augmentation for Management of Neophallus Fat Atrophy After Penile Implant Insertion: Surgical Technique and Outcomes

To describe our surgical technique and outcomes of glans augmentation with autologous adipodermal or acellular dermal matrix (ADM) interposition grafts for fat atrophy of the neophallus following penile implant insertion. We retrospectively reviewed the outcomes of glans augmentation in phalloplasty patients presenting with fat atrophy following penile prosthesis insertion. Glans augmentation is performed by making a small posterior coronal incision to preserve the shaft-to-glans dermal blood supply. A plane is made between the glans skin and the capsule of the distal penile implant cylinder. An adipodermal graft or ADM sheet graft is then sized to the glans dissection space and inserted, covering the implant capsule and filling the glans. The graft harvest site and posterior coronal incisions are then closed. The primary postoperative outcome was the recurrence of implant glans skin impingement or erosion. From October 2017 through January 2023, 15 patients underwent glans augmentation after penile prosthesis insertion. The mean follow-up was 20 months. Adipodermal grafts were placed in 12 (80%) patients and ADM grafts in 3 (20%) patients. Two patients developed complications requiring surgical revision and 3 patients are considering a secondary glans augmentation, for a potential surgical revision rate of 33% (5/15). There were no wound infections, implant infections, or erosions. Glans augmentation with adipodermal or ADM graft interposition between the glans skin and implant capsule improves the neophallus appearance and may help prevent future implant erosion in phalloplasty patients who develop fat atrophy after penile implant insertion.

Single Stitch Vicryl Mesh Wrap for Prepectoral Implant Breast Reconstruction.

Acellular dermal matrices are commonly used in prepectoral breast reconstruction for implant coverage and support, but they are associated with significant costs. The authors describe a technique for prepectoral breast reconstruction in which the implant is completely wrapped in a knitted Vicryl mesh and then positioned on the chest, without the need for any tacking sutures. A retrospective review was performed on all consecutive prepectoral breast reconstructions, using this technique at a single institution. A separate cohort undergoing prepectoral reconstruction with a conventional acellular dermal matrix technique was also reviewed for comparison. Patient demographics, oncologic and reconstruction characteristics, outcomes, complications, and materials cost were analyzed. Twelve patients (23 breasts) underwent prepectoral reconstruction with Vicryl mesh, and 34 patients (55 breasts) underwent prepectoral reconstruction with acellular dermal matrices. Overall complication rates in the Vicryl group were low (two infections, one case of skin necrosis, one hematoma) and did not differ statistically from the acellular dermal matrix group. Operative time per breast was nearly twice as fast (35.7 versus 68.0 min, P < 0.01). Calculated materials cost savings was $8273 per breast. Prepectoral breast reconstruction with Vicryl mesh only is a safe technique that is much faster and significantly cheaper compared with conventional reconstructive techniques utilizing acellular dermal matrices.

What Should We Know in Postoperative Surveillance Imaging After Oncoplastic Breast-Conserving Surgery with Pellet-Type Acellular Dermal Matrix?

The aim of this study was to evaluate the usual postoperative imaging findings among patients who underwent oncoplastic breast-conserving surgery (BCS) with acellular dermal matrix (ADM) and to assess the clinical utility of mammography (MG) and ultrasonography (US) in follow-ups. This retrospective review of our prospectively collected database of patients who underwent oncoplastic BCS with ADM was conducted with IRB approval and in HIPPA compliance. A total of 105 patients whose follow-up MG and US studies over 2years after surgery were available were included in this study. Postoperative imaging findings were analyzed based on sequential MG and US follow-ups. The clinical outcomes and pathological data were also reviewed. The diagnostic performance of MG and US for postoperative surveillance was assessed. On MG, ADM presented as an oval (99/105, 94.3%), circumscribed/obscured (65/105, 61.9%), and high-density (56/105, 53.3%) mass with calcifications (54/105, 51.4%). On US, the ADM-filled cavity presented as an oval (93/105, 88.6%), circumscribed (70/105, 66.7%), heterogenous echoic (65/105, 61.9%) mass with marginal/posterior acoustic shadowing (95/105, 90.5%) on US. During the follow-up period (mean, 46.1months; range, 26-58months), four tumor recurrences were diagnosed (4/105, 3.8%). One tumor recurrence detected on MG presented as microcalcifications (1/4, 25%), which were differentiated from benign postoperative calcifications due to their suspicious morphology and location. Two additional recurrences (2/4, 50%), which were MG-negative small masses or intraductal lesions, were detected on US. One tumor recurrence was missed on both MG+US and was detected by magnetic resonance imaging performed at clinician's request. The sensitivity and specificity of MG, US, and MG+US for postoperative surveillance were 25%, 50% and 75% and 100%, 98% and 98%, respectively. Recognition and adequate interpretation of the usual findings after oncoplastic BCS with ADM insertion are important in postoperative imaging surveillance. The sole use of MG is not sufficient for the detection of mass-type tumor recurrence due to the density of inserted ADM fillers. Therefore, the combined use of MG+US could serve as a useful postoperative surveillance tool with increased sensitivity in this population.

Catch-22: Acellular Dermal Matrix and U.S. Food and Drug Administration Premarket Approval-How Can We Construct Studies?

DeLong, Michael R. MD1; Otterburn, David M. MD2; Festekjian, Jaco H. MD1 Author Information

Early Complications in Prepectoral Breast Reconstructions with and without Acellular Dermal Matrix: A Preliminary Analysis of Outcomes.

Prepectoral tissue expander (TE) placement for two-stage postmastectomy reconstruction is usually performed in conjunction with insertion of acellular dermal matrix (ADM). However, the effects of ADM use on TE loss or other early complications remain unknown. Therefore, the aim of this study was to compare early postoperative complications in patients who underwent prepectoral breast implant reconstruction with or without ADM use. The authors performed a retrospective cohort study of all patients at their institution who underwent prepectoral breast reconstruction from January of 2018 to June of 2021. The primary outcome was TE loss within 90 days of surgery; secondary outcomes included other complications such as infection, TE exposure, mastectomy skin flap necrosis requiring revision, and seroma. Data on 714 patients with 1225 TEs (1060 with ADM and 165 without) were analyzed. Baseline demographics did not differ by ADM use, although mastectomy breast tissue weight was higher in patients without ADM (750.3 g versus 540.8 g; P < 0.001). Rates of TE loss were similar in reconstructions with (3.8%) ADM and without (6.7%; P = 0.09). We also did not find differences in the rates of secondary outcomes between cohorts. ADM use had no statistically significant effect on early complication rates among patients undergoing breast reconstruction with prepectoral TEs. Still, this study was underpowered, and data trended toward statistical significance; thus, larger studies are required in the future. Additional research and randomized studies should focus on larger cohorts and examine long-term complications such as capsular contracture and implant malposition. Therapeutic, III.

Acellular Dermal Matrix Cover Improves Skin Growth during Tissue Expansion by Affecting Distribution of Mechanical Forces.

Biological cover over tissue expander prostheses has been introduced to provide soft-tissue support for tissue expanders during breast reconstruction. However, its impact on mechanically induced skin growth remains unknown. This study investigates the hypothesis that covering the tissue expander with acellular dermal matrix (ADM) affects mechanotransduction without compromising the efficacy of tissue expansion. Tissue expansion, with and without use of ADM, was performed on a porcine model. The tissue expanders were inflated twice with 45 mL of saline, and the full-thickness skin biopsy specimens were harvested from expanded and control unexpanded skin 1 week and 8 weeks after the final inflation. Histologic evaluation, immunohistochemistry staining, and gene expression analysis were performed. Skin growth and total deformation were evaluated using isogeometric analysis. The authors' results demonstrate that use of ADM as a biological cover during tissue expansion does not impede mechanotransduction that leads to skin growth and blood vessel formation. Isogeometric analysis revealed similar total deformation and growth of expanded skin with and without a biological cover, confirming that its use does not inhibit mechanically induced skin growth. In addition, the authors found that use of an ADM cover results in more uniform distribution of mechanical forces applied by the tissue expander. These results suggest that ADM improves mechanically induced skin growth during tissue expansion by facilitating a more uniform distribution of mechanical forces applied by the tissue expander. Therefore, the use of a biological cover has potential to improve outcomes in tissue expansion-based reconstruction.

The effect of intraoperative immersion solutions on acellular dermal matrix: Biofilm formation and mechanical property

Acellular dermal matrix (ADM) is generally used on implant-based breast operations; However, it can increase surgical site infection. Many immersion solutions are applied to ADM, however, the most effective solution is unknown. The purpose of this study is to determine the effect of different solutions on the biofilm formation and mechanical properties of ADM. Aseptic porcine-derived ADMs were immersed in 5 different solutions for 30min; sterile normal saline, 10% povidone-iodine, 0.5% chlorhexidine, antibiotics (cefazolin, gentamicin, and vancomycin), and taurolidine. They are transferred to 10ml suspension of methicillin-sensitive/resistant Staphylococcus aureus (MSSA/MRSA) or Staphylococcus epidermidis and an overnight culture was performed. After rinsing and sonication to obtain the biofilm on ADM, colony forming unit (CFU) was measured. In addition, the maximum load before ADM deformation and the elongation length of ADM at the start of the maximum load was determined. Regardless of strains, povidone-iodine, chlorhexidine, and taurolidine group had lower CFUs than the saline group with statistical significance. Meanwhile, the antibiotics group did not show statistical difference from the saline group. Moreover, only taurolidine group showed higher tensile strength (MRSA, p=0.0003; S. epidermidis, p=0.0023) and elongation length (MSSA, p=0.0015) than the saline group. The antibiotics and chlorhexidine group yielded lower tensile strength and elongation length than the povidone-iodine and taurolidine groups. It was suggested that the 10% povidone-iodine or taurolidine solution is effective. In contrast, the antibiotics solution could be considered as an effective intraoperative solution.

173. The Rise Of Acellular Dermal Matrix: Cost Consciousness, Industry Payments, And Publication Productivity

PURPOSE: Acellular dermal matrix (ADM) has become commonplace in reconstructive surgery. It is estimated to be used in nearly half of all alloplastic breast reconstructive procedures in the US and has been the focus of approximately 500 plastic surgery publications since its adoption. However, ADM is yet to be FDA approved for breast reconstruction, and remains costly compared to potentially noninferior alternatives such as synthetic mesh and autologous reconstruction. An aim of this investigation was to describe external factors associated with the rise of ADM usage over the past two decades in plastic surgery. Attention was paid to report individual ADM-related academic output and correlation with industry funding or public interest in the costs of plastic surgery. METHODS: All PubMed indexed studies focusing on ADM, in eleven plastic surgery journals, were included (n=534). Data on industry funding to the 17 authors with five or more first and last author publications were extracted from the Open Payments Database. The 125 publications from the top 17 authors were reviewed for disclosure of funding and specific study type. To measure public interest, Google Trends in “plastic surgery cost” and “breast surgery cost”-related searches were queried. Relationships between publication quantity, author industry funding, author disclosure rate, and public interest were analyzed by Pearson’s Correlation and linear regression. RESULTS: ADM-focused studies were published at an approximate rate of 4/year from 2000-09 with a precipitous peak to 71 publications in 2012 and subsequent normalization to approximately 36/year. The 17 most-published authors produced eight qualifying publications on average [5-17]. These individuals grossed a total of $19million industry dollars overall with $17M (89%) in non-consulting compensation from ADM-producing companies (NC-ADM).Median/quartile individual total compensation and NC-ADM compensation were $194K/$320K/$1.25M and $17K/$210K/$1.1M respectively. These variables showed strong correlation with individual publication rate [r=0.662 & r=0.647, (p<0.01*)] with a linear regression coefficient of $110K per NC-ADM publication (p< 0.01*). Authors disclosed funding in a mean of 65 ± 26% of their work with a strong correlation between disclosure rate and NC-ADM (r=0.576, p=0.02*). Google trends for searches regarding “breast surgery cost” increased significantly with time (r = 0.822, p <0.001*) and were in strong correlation with ADM-related publications (r=0.671, p<0.01*). CONCLUSION: This study demonstrates significant correlations between ADM-related publications, industry funding, funding disclosure, and public interest. Education in the potential for such relationships and the importance of objectivity in operative protocol design is necessary. Continued analysis for potential biases in evidence and transparency in publication are critical when adopting new techniques and technology.

SP32. Predicting The “Crunch”: Capsular Contraction Prediction in Two-stage Breast Reconstruction Using Neural Network

PURPOSE: Two-stage breast reconstruction is a common technique used to restore pre-operative appearance in patients undergoing mastectomy. However, capsular contracture may develop and lead to significant discomfort. The objective of this study is to build a machine learning model that can evaluate the risk of capsular contracture after two-stage breast reconstruction. METHODS: 209 women (406 samples) were included in the cohort. Patient characteristics that remained statistically significant predictors of capsular contracture were included as input data in the machine learning model. Supervised learning models were evaluated using k-fold cross validation (k=3). A neural network model was also evaluated with a 0.8/0.1/0.1 train/validate/test split on the dataset. RESULTS: Among the subjects, 144/406 (35.47%) developed capsular contracture. Older age (OR 1.0), smaller nipple-inframammary fold distance (OR 0.90), slower tissue expansion rate/longer time delay (OR 0.998), and the use of post-operative radiation (OR 3.46) increased odds of capsular contracture (p<0.05). Neural network achieved the best performance metrics among the models tested, with test accuracy of 0.82 and ROC AUC 0.79. CONCLUSION: To our knowledge, this is the first study that uses neural network model to predict the development of capsular contraction after two-stage implant-based breast reconstruction. The application of machine learning will allow for better counseling of patients prior to breast reconstruction. High risk patients may be guided to autologous reconstruction or advised of the potential for additional surgeries. It may also provide better instruction on who should use acellular dermal matrix or other adjuvant techniques at the time of initial reconstruction.

SP35. Impact of Acellular Dermal Matrix (ADM) Thickness on Complications During Two-stage Implant-based Breast Reconstruction

SP35. Impact of Acellular Dermal Matrix (ADM) Thickness on Complications During Two-stage Implant-based Breast Reconstruction

44. The Effect of Acellular Dermal Matrix on Skin Growth and Collagen Deposition Induced by Tissue Expansion

44. The Effect of Acellular Dermal Matrix on Skin Growth and Collagen Deposition Induced by Tissue Expansion

43. Incorporation of Nitroglycerin into Acellular Dermal Matrix Hydrogel to Improve Perfusion to Skin Envelope in Implant-based Breast Reconstruction

43. Incorporation of Nitroglycerin into Acellular Dermal Matrix Hydrogel to Improve Perfusion to Skin Envelope in Implant-based Breast Reconstruction

The Use of Acellular Dermal Matrix for the Closure of Skin Defects

Background &amp; Objectives: Skin substitutes are a diverse set of biologics, synthetics, and biosynthetic materials that can replace open skin wounds temporarily or permanently. Skin substitutes are designed to mimic the qualities of natural skin. One must select an option that accomplishes an excellent wound healing and closure. This study aimed to assess the reliability and effectiveness of ?acellular dermal matrix for potentially more pliable coverage of the wound and for better ?functional and aesthetic appearance of the skin defects. Methods: A prospective cohort study performed on 20 patients with full-thickness skin defects who underwent surgery using acellular dermal substitute and skin grafting in Erbil Governorate from January 2017 to December 2019. Functional and aesthetic outcome has been evaluated in this study. Results: The study included 20 patients with mean age of 18.8 ± 6.2 years, female to male ratio was 1.5:1, and the majority of the cases presented with burn (90%). The Vancouver Scar Scale score was significantly reduced after 1 month of follow-up in which it reduced by 4.12 mm (57.6% reduce from baseline), Mean healing score was 93.5%, and Re-epithelialization after 1 month Was 95.55%, Overall the complication rate is low with 5% had hematoma, 5% had infection and 5% had loss of graft. Conclusion: The use of acellular dermal matrix in conjunction with split thickness skin graft result in substantial improvement in the quality of wound healing and tissue reconstruction.

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

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.