Repair of giant subcostal hernia using porcine acellular dermal matrix (Strattice™) with bone anchors and pedicled omental flap coverage: a case report

Journal of Medical Case Reports

Bryan Richmond¹  J David Hayes³  Jonathan King² 

[1] Department of Surgery, West Virginia University/Charleston Division, 3110 MacCorkle Avenue SE, Charleston, WV 25304, USA;West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, WV 26506, USA;Charleston Area Medical Center Plastic Surgery Center, 501 Morris Street, Charleston, WV 25301, USA

关键词: Strattice;    Porcine acellular dermal matrix;    Omental flap;    Hernia;    Subcostal;   

Others  :  824981
DOI  :  10.1186/1752-1947-7-258

 received in 2013-06-14, accepted in 2013-09-14,  发布年份 2013

【 摘 要 】

Introduction

Giant abdominal wall hernias represent a major challenge to the hernia surgeon in practice today. Of the common abdominal wall hernias, those located in the subcostal region are among the most difficult to repair, and have historically been plagued by higher recurrence rates than other locations, such as the midline. No technique has been identified as the clearly superior choice for hernias of this type.

Case presentation

We report a successful repair of a giant, multiply recurrent subcostal hernia with loss of domain in a 45-year-old obese Caucasian man. This was accomplished in a novel fashion, using a porcine acellular dermal matrix (Strattice™) as the floor of the repair, which was fixed to the costal margin using orthopedic bone anchors (Mitek™), then covered with a pedicled omental flap to eliminate dead space and facilitate a more rapid revascularization of the porcine acellular dermal matrix implant.

Conclusions

This case emphasizes the need for a thorough understanding of the challenges of the specific type of hernia defect encountered, as well as knowledge of any available techniques that may be adjunctively employed to enhance the chances of achieving a successful result.

【 授权许可】

   
2013 King et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

Figure 6.

Figure 7.

【 参考文献 】

• [1]Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J: Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 2004, 240:578-583.
• [2]Luijendijk R, Hop W, van den Tol M, de Lange D, Braaksma M, Ijzermans J, Boelhower R, de Vries B, Salu M, Wereldsma J, Bruijninckx C, Jeekel J: A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 2000, 343:392-398.
• [3]Korenkov M, Paul A, Sauerland S, Neuebauer E, Arndt M, Chevrel JP, Corcione F, Fingerhut A, Flament JB, Kux M, Matzinger A, Myrvold HE, Rath AM, Simmermacher RK: Classification and surgical treatment of incisional hernia: results of an experts’ meeting. Langenbeck’s Arch Surg 2001, 386:65-73.
• [4]Cassar K, Munro A: Surgical treatment of incisional hernia. Br J Surg 2002, 98:534-545.
• [5]Moreno-Egea A, Carrillo A: Management of non-midline incisional hernia by the laparoscopic approach: results of a long-term follow-up prospective study. Surg Endosc 2012, 26:1069-1078.
• [6]Baumann D, Butler C: Lateral abdominal wall reconstruction. Semin Plast Surg 2012, 26:40-48.
• [7]Stumpf M, Conze J, Prescher A, Junge K, Krones CJ, Klinge U, Schumpelick V: The lateral incisional hernia: anatomical considerations for a standardized retromuscular sublay repair. Hernia 2009, 13:293-297.
• [8]Sun R, Choi K, Coots B: The use of the Mitek anchoring system on the iliac crest for flank incisional hernia repair. Eur J Plast Surg 2013, 36:335-338.
• [9]Breuing K, Butler CE, Ferzoco S, Franz M, Hultman C, Kilbridge J, Rosen M, Silverman R, Vargo D, for the Ventral Hernia Working Group: Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 2010, 148:544-558.
• [10]Butler CE, Langstein HN, Kronowitz SJ: Pelvic, abdominal, and chest wall reconstruction with AlloDerm in patients at increased risk for mesh-related complications. Plast Reconstr Surg 2005, 116:1263-1275. discussion 1276–1277
• [11]Butler C, Burns N, Campbell K, Mathur A, Jaffari M, Rios C: Comparison of cross-linked and non-cross-linked porcine acellular dermal matrices for ventral hernia repair. J Am Coll Surg 2010, 211:368-376.
• [12]Parra MW, Rodas EB, Niravel AA: Laparoscopic repair of potentially contaminated abdominal ventral hernias using a xenograft: a case series. Hernia 2011, 15:575-578.
• [13]Gu Y, Tang R, Gong D, Qian Y: Reconstruction of the abdominal wall by using a combination of the human acellular dermal matrix and an interpositional omentum flap after extensive tumor resection in patients with abdominal wall neoplasm: a preliminary result. World J Gastroenterol 2008, 14:752-757.
• [14]Wong C, Tan B, Koong H, Lim C, Chia S, Song C: Use of the omentum flap as additional soft-tissue cover for abdominal wall defects reconstructed with Gore-tex. Plast Reconst Surg 2005, 116:1715-1720.