Outcomes after abdominal wall reconstruction using acellular dermal matrix: A systematic review

Background: Complex abdominal wall defects can present a significant challenge to the reconstructive surgeon. In 2003, acellular dermal matrix (ADM) was introduced as an alternative to synthetic materials with suggestions that it has improved capacity to integrate with surrounding tissues with less inclination towards infection, erosion, extrusion, adhesion formation and rejection compared with synthetic materials. This systematic review was conducted to evaluate the existing literature describing the use of ADM for abdominal wall reconstruction in an attempt to identify factors that may affect outcomes. Methods: A review of the MEDLINE database using the search terms 'dermal matrix' and 'abdomen' or 'hernia' for prospective and retrospective human studies in English was performed. Exclusion criteria were animal studies, case reports, reviews and articles that dealt only with ADM for repair of congenital abdominal wall defects, hiatal, parastomal or inguinal hernias and enterocutaneous fistulae. Two independent reviewers performed the systematic review with the same a priori criteria, with discrepancies reconciled by the senior author. Results: In October 2010, 3394 articles were identified as potentially inclusive based on the search term 'dermal matrix'. When filtered for 'abdomen' or 'hernia', 83 articles were found. Ultimately, 30 articles met criteria. No other systematic reviews, meta-analyses or randomised controlled trials were identified in the existing literature. Conclusions: At this current time, there is a paucity of high-level evidence comparing ADM with other methods interfering with the ability of physicians to make data-driven recommendations on clinical indications, surgical techniques and outcomes following ADM-assisted abdominal wall reconstruction.