Repair of Recurrent Ventral Hernias Using a Combination of Tissue Expansion and Non–Cross-linked Intact Porcine-derived Acellular Dermal Matrix

Background: Recurant ventral hernias are problematic for reconstructive plastic surgeons. These patients usually have large hernias and a loss of abdominal wall domain that make primary closure of the hernia impossible. The standard intervention in these patients is a component separation procedure that advances muscle from the lateral abdomen; this results in primary closure of the abdomen without creating tension. However, the relaxing incisions weaken the lateral abdominal wall, resulting in lateral abdominal wall weakness and bulging. We propose an approach to primary midline closure that does not compromise lateral abdominal wall stability.

Methods: In three patients with recurrent ventral hernias who had failed two or more repair attempts, we used a two-stage procedure consisting of initially placing bilateral rectangular tissue expanders between the external and internal oblique muscles via subcostal incisions, followed by expansion for 6 to 8 weeks. Second-stage surgery consisted of expander removal and primary closure of the abdominal defect reinforced by an underlay and overlay of non–cross-linked porcine-derived acellular dermal matrix.

Results: Primary closure was achieved in all patients with no need for component separation. At up to 1-year follow-up, all patients had structurally intact abdomens with no hernia recurrence and no lateral bulging. 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 acellular dermal matrix allows strong and reliable primary closure of recurrent ventral hernias without the need for component separation.