Abstract
Background
Recurrent ventral hernias are often large and associated with loss of abdominal domain, hindering primary closure. One established intervention for patients with large ventral hernias is the component separation procedure that advances muscle from the lateral abdomen. This technique allows closure without creating tension; however, the relaxing incisions weaken the lateral abdominal wall by altering its natural architecture. We propose an approach to primary midline closure that does not compromise lateral abdominal wall stability and restores the architecture of the abdominal wall while allowing tension-free midline closure.
Methods
In three patients with recurrent ventral hernias who had failed two or more repair attempts, we used a two-stage reconstruction. Bilateral rectangular tissue expanders placed between the external and internal oblique muscles via subcostal incisions were expanded for 6–8 weeks. Second-stage surgery consisted of expander removal and primary closure of the abdominal defect reinforced by an underlay and overlay of noncross-linked intact porcine-derived acellular dermal matrix (PADM; Strattice™ Reconstructive Tissue Matrix, LifeCell, Branchburg, NJ, USA).
Results
Primary closure of ventral hernias measuring 8 × 8, 12 × 8, and 8 × 6 cm was achieved with no need for component separation. At follow-up ranging from 10 to 17 months, all patients had structurally intact abdomens with no hernia recurrence and no abdominal wall weakness. All patients have resumed normal daily activities, including returning to work.
Conclusions
Expansion of the external and internal oblique muscles combined with an underlay and overlay of noncross-linked intact PADM allows strong and reliable primary closure of recurrent ventral hernias without the need for component separation.
Level of evidence: Level V, therapeutic study
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Acknowledgments
Editorial support for this article was provided by Peloton Advantage, LLC, Parsippany, NJ, USA and funded by LifeCell, Branchburg, NJ, USA. The opinions expressed in this article are those of the authors. The authors received no honoraria/fee for service or other form of financial support related to the development of this article.
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Tauber, D.M., Polynice, A. Repair of recurrent ventral hernias using tissue expansion and porcine acellular dermal matrix. Eur J Plast Surg 36, 237–246 (2013). https://doi.org/10.1007/s00238-012-0800-5
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DOI: https://doi.org/10.1007/s00238-012-0800-5