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Full-thickness skin graft vs. synthetic mesh in the repair of giant incisional hernia: a randomized controlled multicenter study.
Department of Clinical Science, Intervention and Technology (CLINTEC), H9, Karolinska Institutet, 171 64, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 64, Stockholm, Sweden.. (Clister)
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. (Clister)
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. (Clister)
2017 (English)In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204Article in journal (Refereed) Epub ahead of print
Abstract [en]

PURPOSE: Repair of large incisional hernias includes the implantation of a synthetic mesh, but this may lead to pain, stiffness, infection and enterocutaneous fistulae. Autologous full-thickness skin graft as on-lay reinforcement has been tested in eight high-risk patients in a proof-of-concept study, with satisfactory results. In this multicenter randomized study, the use of skin graft was compared to synthetic mesh in giant ventral hernia repair.

METHODS: Non-smoking patients with a ventral hernia > 10 cm wide were randomized to repair using an on-lay autologous full-thickness skin graft or a synthetic mesh. The primary endpoint was surgical site complications during the first 3 months. A secondary endpoint was patient comfort. Fifty-three patients were included. Clinical evaluation was performed at a 3-month follow-up appointment.

RESULTS: There were fewer patients in the skin graft group reporting discomfort: 3 (13%) vs. 12 (43%) (p = 0.016). Skin graft patients had less pain and a better general improvement. No difference was seen regarding seroma; 13 (54%) vs. 13 (46%), or subcutaneous wound infection; 5 (20%) vs. 7 (25%). One recurrence appeared in each group. Three patients in the skin graft group and two in the synthetic mesh group were admitted to the intensive care unit.

CONCLUSION: No difference was seen for the primary endpoint short-term surgical complication. Full-thickness skin graft appears to be a reliable material for ventral hernia repair producing no more complications than when using synthetic mesh. Patients repaired with a skin graft have less subjective abdominal wall symptoms.

Place, publisher, year, edition, pages
2017.
Keywords [en]
Abdominal wall reconstruction, Full-thickness skin, Hernia complication, Incisional hernia, Infection, Ventral hernia
National Category
Surgery
Identifiers
URN: urn:nbn:se:umu:diva-143226DOI: 10.1007/s10029-017-1712-xPubMedID: 29247365OAI: oai:DiVA.org:umu-143226DiVA, id: diva2:1167779
Available from: 2017-12-19 Created: 2017-12-19 Last updated: 2018-06-09

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Gunnarsson, UlfStrigård, Karin

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