The role of bioprosthetics in abdominal wall reconstruction

In several common situations, bioprosthetic materials may have distinct advantages over synthetic mesh and autologous flap or graft techniques for abdominal wall reconstruction. These off-the-shelf materials entail no donor site morbidity and are used successfully in contaminated wounds owing to their ability to resist infection, become revascularized and incorporated into host tissue, and reduce visceral adhesions. Fibrovascular incorporation into surrounding tissues and implant remodeling reduce the risks associated with a persistent foreign body, such as chronic infection, enterocutaneous fistulae, and cutaneous exposure. Disadvantages of bioprosthetic materials include higher implant cost relative to synthetic mesh, limited size of individual sheets in some cases, and risk of seroma formation. Bioprosthetic mesh has been used for abdominal wall reconstruction for approximately 5 years, so long-term studies are not available. Current laboratory and clinical evidence suggests that these materials provide a strong, durable musculofascial repair when used for abdominal wall repair. Further studies and ongoing clinical experience will be important in determining the indications for which bioprosthetic mesh will have the greatest impact. Currently available commercial products have distinct differences that result in varied clinical biologic and physiologic activity. New products and modifications to existing products may further enhance the benefits of bioprosthetic mesh, particularly in challenging cases. The use of bioprosthetic mesh has attracted interest in a relatively short period of time, with rapidly increasing indications and volume of cases successfully performed. Bioprosthetic mesh likely will play a progressively greater role in trunk reconstruction in the future.