WOC nurse wound consult: negative pressure wound therapy.
Emory University WOCNEC, Atlanta, Georgia 30322, USA.Journal of wound, ostomy, and continence nursing: official publication of The Wound, Ostomy and Continence Nurses Society / WOCN (Impact Factor: 1.17). 36(5):483-5. DOI:10.1097/WON.0b013e3181b51f84
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ABSTRACT: Surgeons continue to search for the ideal prosthetic material to repair complex abdominal wall hernias. Recently, a new biologic material was introduced into the surgeon's arsenal. The purpose of this study is to review a single institution's experience with the use of human acellular dermal matrix (HADM [AlloDerm]) for repair of hernias. This was a retrospective review of all patients who received HADM for repair of an abdominal wall hernia. Patient demographics, comorbidities, wound contamination, operative technique, complications, and hernia recurrence were analyzed. Between May 2004 and October 2007, HADM was implanted in a total of 46 patients undergoing repair of a ventral hernia. The average age was 54 years (range, 26-77), with an average American Society of Anesthesiologists classification of 2.5 (range, 1-4). Indications for use of HADM included complex ventral hernia repair (n = 34), mesh infection/enterocutaneous fistula (n = 10), and peritonitis (n = 2). The incidences of comorbidities were hypertension in 47%, diabetes mellitus in 16%, and coronary artery disease in 11%. The majority (87%; n = 40) of the procedures were performed on an elective basis. Seventeen procedures were performed in contaminated wounds. The HADM was placed as reinforcement to the hernia repair in 26 patients and as a "bridge" between the fascial edges in 20 patients. The average follow-up was 12.1 months. Wound complications were frequent at 54%. There were 6 recurrent hernias and 8 patients with eventration of the bioprosthesis so that the recurrent hernia rate was 30%. None of the recurrences were associated with a postoperative wound infection. The majority (88%) of patients who developed eventration of the HADM had a repair using the bioprosthesis to "bridge" an abdominal wall defect. Hernia recurrence and eventration were not associated with use of HADM in a contaminated/infected wound. HADM is a suitable prosthesis for repair of complex and routine abdominal wall defects. This bioprosthesis can incorporate into contaminated tissue without becoming infected. Eventration occurs when HADM is utilized as a fascial replacement rather than as a reinforcement.Surgery 11/2008; 144(4):703-9; discussion 709-11. · 3.37 Impact Factor
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ABSTRACT: Parastomal hernias occur frequently in patients with inflammatory bowel disease who require a stoma and are associated with high recurrence rates. The tissue weakness at the site of hernia can be overcome by creating neofascia using two separate layers of human acellular dermal matrix. Thirteen consecutive patients with inflammatory bowel disease with symptomatic parastomal hernia underwent open parastomal hernia repair at an academic tertiary referral center whereby the posterior and anterior rectus fascia at the stoma site was reconstructed with human acellular dermal matrix. Patients were followed prospectively for 290 +/- 119 days (mean +/- standard deviation), and data were reviewed for rate of postoperative complications, hernia recurrence, and patient satisfaction. Mean operative time was 233 +/- 80 (range, 129-355) minutes. No intraoperative complications occurred. Average hospital stay was 8.1 +/- 2.4 (range, 6-14) days. Postoperative complications included seroma formation, incisional separation (2 patients each, 15.4 percent), and superficial wound infection (1 patient, 7.7 percent). There were two cases of asymptomatic hernia recurrence as determined by computerized tomography. These patients did not require any intervention. Overall patient satisfaction with the procedure was high. In patients with parastomal hernia, reconstruction of the stoma site and abdominal wall with human acellular dermal matrix seems to be safe and results in high patient satisfaction.Diseases of the Colon & Rectum 03/2009; 52(2):349-54. · 3.34 Impact Factor
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