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Component Separation Decreases Hernia Recurrence Rates in Abdominal Wall Reconstruction with Biologic Mesh.
Giordano, Salvatore; Garvey, Patrick B; Mericli, Alexander; Baumann, Donald P; Liu, Jun; Butler, Charles E.
Afiliação
  • Giordano S; From the Department of Plastic Surgery, University of Texas MD Anderson Cancer Center.
  • Garvey PB; From the Department of Plastic Surgery, University of Texas MD Anderson Cancer Center.
  • Mericli A; From the Department of Plastic Surgery, University of Texas MD Anderson Cancer Center.
  • Baumann DP; From the Department of Plastic Surgery, University of Texas MD Anderson Cancer Center.
  • Liu J; From the Department of Plastic Surgery, University of Texas MD Anderson Cancer Center.
  • Butler CE; From the Department of Plastic Surgery, University of Texas MD Anderson Cancer Center.
Plast Reconstr Surg ; 153(3): 717-726, 2024 Mar 01.
Article em En | MEDLINE | ID: mdl-37285202
BACKGROUND: 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. METHODS: 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). RESULTS: 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. CONCLUSION: 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. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Produtos Biológicos / Parede Abdominal / Hérnia Ventral Tipo de estudo: Observational_studies Limite: Humans Idioma: En Revista: Plast Reconstr Surg Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Produtos Biológicos / Parede Abdominal / Hérnia Ventral Tipo de estudo: Observational_studies Limite: Humans Idioma: En Revista: Plast Reconstr Surg Ano de publicação: 2024 Tipo de documento: Article