Critical Analysis of Strattice Performance in Complex Abdominal Wall Reconstruction: Intermediate–Risk Patients and Early Complications

Abstract The purpose of this study was to analyze the performance of a porcine-derived acellular dermal matrix (Strattice Reconstructive Tissue Matrix) in patients at increased risk for perioperative complications. We reviewed medical records for patients with complex abdominal wall reconstruction (AWR) and Strattice underlay from 2007 to 2010. Intermediate-risk patients were defined as having multiple comorbidities without abdominal infection. Forty-one patients met the inclusion criteria (mean age, 60 years; mean body mass index, 35.5 kg/m2). Comorbidities included coronary artery disease (63.4%), diabetes mellitus (36.6%), and chronic obstructive pulmonary disease (17.1%). Fascial closure was achieved in 40 patients (97.6%). Average hospitalization was 6.4 days (range, 1–24 days). Complications included seroma (7.3%), wound dehiscence with Strattice exposure (4.9%), cellulitis (2.4%), and hematoma (2.4%). All patients achieved abdominal wall closure with no recurrent hernias or need for Strattice removal. Patients with multiple comorbidities at intermediate risk of postoperative complications can achieve successful, safe AWR with Strattice.

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Early Fascial Closure of the Damage Control Abdomen in Children

The American Surgeon ◽

10.1177/000313481007600517 ◽

2010 ◽

Vol 76 (5) ◽

pp. 497-501 ◽

Cited By ~ 2

Author(s):

Myrick C. Shinall ◽

Kaushik Mukherjee ◽

Harold N. Lovvorn

Keyword(s):

Abdominal Wall ◽

Ventral Hernia ◽

Damage Control ◽

Necrotizing Pancreatitis ◽

Abdominal Wall Reconstruction ◽

Acellular Dermal Matrix ◽

Fascial Closure ◽

Time Range ◽

Dermal Matrix ◽

Abdominal Closure

Traditional staged closure of the damage control abdomen frequently results in a ventral hernia, need for delayed abdominal wall reconstruction, and risk of multiple complications. We examined the potential benefits in children of early fascial closure of the damage control abdomen using human acellular dermal matrix (HADM). We reviewed our experience with five consecutive children sustaining intra-abdominal catastrophe and managed with damage control celiotomy. To accomplish early definitive abdominal closure, HADM was sewn in place as a fascial substitute; the skin and subcutaneous layers were approximated over silicone drains. The five patients ranged in age from 1 month to 19 years at the time of presentation. Intra-abdominal catastrophes included complex bowel injuries after blunt trauma in two children, necrotizing pancreatitis and gastric perforation in one teenager, necrotizing enterocolitis in one premature infant, and perforated typhlitis in one adolescent. All damage control wounds were dirty. Time range from initial celiotomy to definitive abdominal closure was 6 to 9 days. After definitive closure, one child developed a superficial wound infection. No patient developed a ventral hernia. After damage control celiotomy in children, early abdominal wall closure using HADM may minimize complications associated with delayed closure techniques and the need for additional procedures.

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Seroprevalence of Antibodies against Diphtheria, Tetanus and Pertussis in Adult At-Risk Patients

Vaccines ◽

10.3390/vaccines9010018 ◽

2021 ◽

Vol 9 (1) ◽

pp. 18

Author(s):

Lise Boey ◽

Eline Bosmans ◽

Liane Braz Ferreira ◽

Nathalie Heyvaert ◽

Melissa Nelen ◽

...

Keyword(s):

At Risk ◽

Chronic Diseases ◽

Age Groups ◽

Chronic Obstructive ◽

Solid Organ ◽

Recent Infection ◽

Vaccination Programs ◽

Vaccine Preventable Diseases ◽

Increased Risk ◽

Risk Patients

Patients with chronic diseases are at increased risk of complications following infection. It remains, however, unknown to what extend they are protected against vaccine-preventable diseases. We assessed seroprevalence of antibodies against diphtheria, tetanus and pertussis to evaluate whether current vaccination programs in Belgium are adequate. Antibody titers were assessed with a bead-based multiplex assay in serum of 1052 adults with chronic diseases. We included patients with diabetes mellitus type 1 (DM1) (n = 172), DM2 (n = 77), chronic kidney disease (n = 130), chronic obstructive pulmonary disease (COPD) (n = 170), heart failure (n = 77), HIV (n = 196) and solid organ transplant (SOT) recipients (n = 230). Factors associated with seroprevalence were analysed with multiple logistic regression. We found seroprotective titers in 29% for diphtheria (≥0.1 IU/mL), in 83% for tetanus (≥0.1 IU/mL) and 22% had antibodies against pertussis (≥5 IU/mL). Seroprotection rates were higher (p < 0.001) when vaccinated within the last ten years. Furthermore, diphtheria seroprotection decreased with age (p < 0.001). Tetanus seroprotection was less reached in women (p < 0.001) and older age groups (p < 0.001). For pertussis, women had more often a titer suggestive of a recent infection or vaccination (≥100 IU/mL, p < 0.01). We conclude that except for tetanus, the vast majority of at-risk patients remains susceptible to vaccine-preventable diseases such as diphtheria and pertussis.

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Commentary on ‘Perioperative complications of complex abdominal wall reconstruction with biologic mesh: A pooled retrospective cohort analysis of cohort of 220 patients from two academic centers’

International Journal of Surgery ◽

10.1016/j.ijsu.2020.01.123 ◽

2020 ◽

Vol 75 ◽

pp. 53-54

Author(s):

Meer M. Chisthi

Keyword(s):

Abdominal Wall ◽

Retrospective Cohort ◽

Perioperative Complications ◽

Cohort Analysis ◽

Abdominal Wall Reconstruction ◽

Biologic Mesh ◽

Retrospective Cohort Analysis

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Effect of Wound Contamination on Outcomes of Abdominal Wall Reconstruction Using Acellular Dermal Matrix: 14 Year Experience with More Than 700 Patients

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2021.08.679 ◽

2021 ◽

Author(s):

Abbas M. Hassan ◽

Malke Asaad ◽

Allison J. Seitz ◽

Jun Liu ◽

Charles E. Butler

Keyword(s):

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Acellular Dermal Matrix ◽

Dermal Matrix ◽

Wound Contamination ◽

Acellular Dermal

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Multiple Laparotomies are a Predictor of Fascial Dehiscence in the Setting of Severe Trauma

The American Surgeon ◽

10.1177/000313480507100507 ◽

2005 ◽

Vol 71 (5) ◽

pp. 402-405 ◽

Cited By ~ 5

Author(s):

Mamta Swaroop ◽

Michael Williams ◽

Wendy Ricketts Greene ◽

Jack Sava ◽

Kenneth Park ◽

...

Keyword(s):

Wound Infection ◽

Injury Severity ◽

Damage Control ◽

Wound Dehiscence ◽

Severe Trauma ◽

Outcome Data ◽

Fascial Closure ◽

Trauma Patients ◽

Abdominal Abscess ◽

Increased Risk

The purpose of this study was to determine the incidence of wound dehiscence after repeat trauma laparotomy. We performed a retrospective analysis of adult trauma patients who underwent laparotomy at an urban level 1 trauma center during the past 5 years. Patients were divided into single (SL) and multiple laparotomy (ML) groups. Demographic, clinical, and outcome data were collected. Data were analyzed using χ2, t testing, and ANOVA. Overall dehiscence rate was 0.7 per cent. Multiple laparotomy patients had damage control, staged management of their injuries, or abdominal compartment syndrome as the reason for reexploration. SL and ML patients had similar age and sex. ML patients had a higher rate of intra-abdominal abscess than SL patients (13.7% vs 1.2% P < 0.0001), but intra-abdominal abscess did not predict wound dehiscence in the ML group ( P = 0.24). This was true in spite of the fact that ML patients had a significantly higher Injury Severity Score (ISS) than SL patients (21.68 vs 14.35, P < 0.0001). Interestingly, wound infection did not predict dehiscence. Patients undergoing repeat laparotomy after trauma are at increased risk for wound dehiscence. This risk appears to be associated with intraabdominal abscess and ISS, but not wound infection. Surgeons should leave the skin open in the setting of repeat trauma laparotomy, which will allow serial assessment of the integrity of the fascial closure.

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An Innovative Way to Separate Gastrointestinal and Abdominal Wall Reconstruction after Complex Abdominal Trauma

The American Surgeon ◽

10.1177/000313481708300938 ◽

2017 ◽

Vol 83 (9) ◽

pp. 1001-1006 ◽

Cited By ~ 1

Author(s):

David H. Livingston ◽

David V. Feliciano

Keyword(s):

Abdominal Wall ◽

Damage Control ◽

Abdominal Wall Reconstruction ◽

Skin Grafting ◽

Small Bowel Resection ◽

Fascial Closure ◽

Thickness Skin ◽

Split Thickness Skin Grafting ◽

Staged Approach ◽

Level I

Despite advances in trauma care, a subset of patients surviving damage control cannot achieve fascial closure and require split-thickness skin grafting (STSG) of their open abdomen. Controversy exists as to whether reconstruction of the gastrointestine (GI) should be staged or performed at the time of abdominal wall reconstruction (AWR). Many surgeons do not believe that operations through the STSG can be completed safely or without loss of graft. This series reviews the outcomes of operations for GI reconstruction performed through the elevated healed STSG. Concurrent series on all patients undergoing abdominal operation through the STSG. The technique involves elevating the STSG, lysing adhesions only as needed, avoid detaching underlying omentum or viscera to avoid devascularization, and then reattaching the elevated STSG to the abdominal wall with simple sutures. From 1995 to 2017, 27 patients underwent 40 distinct procedures during 36 separate abdominal reoperations (89% GI) through the elevated STSG approach at three Level I trauma centers at a mean interval of 11 months from application of the STSG. One STSG was lost (patient closed with skin flaps), one patient had 30 per cent loss of the STSG (regrafted), and one patient had 10 per cent loss of the STSG (allowed to granulate). One patient required a small bowel resection for intraoperative enterotomy during a difficult operative dissection. There were no GI complications, intraabdominal infections, or deaths, and all patients were deemed fit to undergo AWR after three months. Major intraabdominal reoperations can be readily and safely accomplished through the elevated STSG approach with a <4 per cent need for regrafting. This staged approach significantly simplifies and increases the safety of a second stage AWR.

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