Factors influencing recurrence in abdominal wall reconstruction (awr) in biologic implants

Background: Interest about use of biologie implants (cross- linked or not) in complex abdominal wall reconstruction has grown up in the last years, supp01ted by literature. From literature review, recurrence rate using non cross-linked biologics ranges from 14.7 to 59% and surgical site infection rate ranges from 28.6 to 3 1.9%. We present recurrence rate and surgical site infection in our experience with cross- linked implants (2005-20 16). Methods: From 2005, we treated 49 patients (Grade 2 or 3, according to Ventral Hernia Working Group) with complex abdominal wall reconstruction by retro-muscolar repair, and posterior component separation when necessary, using a porcine cross- linked acellular derma] matrix. Implants were processed with 2 different cross-linking agents, hexamethylene di isocyanate (group A, n.36) or carbodiimide (group B, n.1 3). Ali patients underwent annua] fo llow-up, including clinical evaluation and computed tomography/MRl scan with Valsalva maneuver. Results: The overall recurrence rate was 8.2% (at a mean follow-up of 59.3 months), with a significantly lower rate in group A (2.8%) vs group B (23%, p < 0.05). No implant was removed. Surgical site infection was not signiticantly different in the 2 groups ( 19 vs 26%, p = 0.8). Conclusion: In our experie nce of complex abdominal wall reconstruction, overall rates of recurrence and surgical site infection using porcine cross- linked acellular dermal matrix are notably lower than those previously reported in literature using a non-cross linked biologie mesh. These results stress the role of proper indications (never in grade 4), mesh selection and site of the implant. These factors appear to play a key role in A WR using biologics.