Repair of infected abdominal wall hernias in obese patients using autologous dermal grafts for reinforcement

Background: Reconstruction of large, infected abdominal wall hernias in obese patients can be extremely challenging. A novel approach to abdominal wall reconstruction in a contaminated setting without the use of prosthetic materials is introduced. Methods: Two patients with massive abdominal wall hernias and infected mesh underwent removal of mesh and abdominal wall reconstruction with the component separation technique. Panniculectomy was performed and a dermal graft was obtained by defatting and deepithelializing the specimen. The dermal graft was then applied in an onlay fashion over the fascial closure or used to bridge a fascial gap. Results: One morbidly obese woman underwent reconstruction with onlay dermal graft reinforcement. She is hernia-free at 16 months. A second obese woman, with two enterocutaneous fistulae, had reconstruction with a dermal graft placed to bridge the midline fascial gap. She is hernia-free at 20 months. Conclusions: Autologous reconstruction of abdominal wall hernias, in the setting of infected prosthetic material, provides an excellent opportunity for successful closure of the defect. Failure of component separation is most commonly due to fascial separations at the midline. Autologous dermal grafts provide an ideal reinforcement of these fascial edges in a contaminated environment.