From the Journals

Outcomes similar for skin graft, synthetic mesh in incisional hernia repair



Giant incisional hernia repair outcomes were similar for full thickness skin graft (FTSG) and synthetic mesh, according to findings published in Hernia.

Open hernia surgery castillodominici/Thinkstock

In a prospective, randomized study of 52 patients (24 who received FTSG and 28 who received synthetic mesh), two recurrences were found at 1-year follow up in each group. Results for pain, patient satisfaction, and aesthetic outcome did not differ significantly between the groups, reported Viktor Holmdahl of the department of surgery and perioperative sciences at Umeå (Sweden) University and his coauthors.

Patients were aged 18 years or older, with symptomatic giant (greater than 10 cm) ventral incisional hernia. All patients had computerized tomography (CT) imaging of the abdominal wall, and were assessed for abdominal wall muscle strength via the Biodex Multi-Joint System-4.

The synthetic mesh used was a polypropylene mesh overlapping the repaired hernia defect by at least 5 cm. The FTSG was always placed in an onlay position, and was taken from excess skin adjacent to the midline incision made for the hernia repair. Postoperative care was identical for both groups, Dr. Holmdahl and his colleagues reported.

At 1 year, all patients received a follow-up Biodex assessment and were evaluated for recurrence. Aesthetic outcomes such as scar appearance and wound healing were assessed. Patients self-reported pain levels using a visual analogue scale.

Two patients in both the FTSG group (8.3%) and the synthetic mesh group (7.1%) had recurrence (P = 1.000). Differences between groups for the other measures were not significant, including for well-healed scars (91.3% for FTSG vs. 96.4% for synthetic mesh) and excess skin (60.9% vs. 57.1%). Biodex results also did not differ significantly between the groups.

The similarities in results between the two techniques “indicate that FTSG possibly has a future role in hernia repair, but more research is needed,” the authors concluded.

The study was supported by the Swedish Research Council and by a regional agreement between Umeå University and Västerbotten County Council. The investigators declared no conflicts of interest.

SOURCE: Holmdahl V et al. Hernia 2019 Feb 8. doi: 10.1007/s10029-019-01900-4.

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