We read with great interest the article by Abdelfatah et al. titled ‘‘Long-term outcomes ([5 year follow-up) with porcine acellular dermal matrix (Permacol) in incisional hernia at risk for infection’’ [1]. This retrospective study included 65 consecutive patients, who underwent abdominal wall reconstruction (AWR) with porcine acellular dermal matrix (PADM) for repair of incisional hernias at high risk for surgical site infection (SSI). The surgical wound was clean in 49 %, clean-contaminated or contaminated in 45 % and infected in 6 % of cases. At the end of the study, authors concluded the use of Permacol PADM is far from ideal to unsatisfactory in the overall picture. Only in selected patients its use might prove to be useful. In fact, results from Abdelfatah et al. are discouraging and PADM as bioprosthesis for ventral hernia appears unreliable as definitive repair at this time. In Abdelfatah series, SSI occurred in 20 % within 30 postoperative days and in 37 % after this period (with 25 % of PADM infection). Infection required subtotal or total removal of PADM in 15 cases. Fifty-nine patients with a follow-up C5 years displayed overall recurrence in 66 %, documented at physical examination or objective findings (CT scan or reoperation). Why these bad results? authors have full knowledge of some limitations of their study, including the heterogeneous differing types of repair, onlay, inlays and sublays with bridging (patches) or reinforcement by the PADM. We absolutely agree with them and we believe that the explanation of such discouraging results actually must be sought in the surgical technique. Abdelfatah et al. report that a bridging patch repair was performed in 31/65 patients, an onlay or intraperitoneal reinforcement of an autogenous suture repair in 28/65 and an inlay repair in 6/65. PADM was never placed as a sublay in the retromuscular space, as described by Rives and Stoppa [2, 3]. Results from our experience are different. Between July 2005 and December 2013, 45 consecutive patients underwent abdominal wall reconstruction (AWR) with PADM (32 with Permacol, Covidien and 13 with CollaMend, Bard, Davol) for incisional hernias. Four patients needed more than one implant, due to concomitant hernias in other sites (parastomal or perineal), for a total number of 50 implants. All patients were at risk of infection, 87 % of them displaying grade III, according to mod.WVHG (Table 1) [4]. In 86 % of implants, PADM was used as augmentation repair while in 14 % of them sublay bridging repair was performed (Table 2). Sixty-eight percent of defects were treated with primary suture of the midline and retromuscular PADM reinforcement (Rives–Stoppa technique). When ventral rectus sheaths could not be reapproximated, techniques of posterior components separation were performed [5, 6]. All patients were collected in a database and examined every year. The presence or absence of recurrent hernias was documented by cross-sectional imaging (CT scan or MRI) with Valsalva manoeuvre. Our short-term SSI rate was quite similar to Abdelfatah et al. (26 vs. 20 %), despite the higher risk of infection in our patients (87 vs. 50 %). In our series, one patient died due to sepsis on 30th postoperative day. Long-term SSI was demonstrated in 2 cases (4 %), both belonging to the This comment refers to the article available at doi:10.1007/s10029013-1165-9.