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Fri Jan 4 14:21:18 GMT 2008

Marc,

There's two issues in  my  small experience — infection and early
failure and late weakening and failure.

In the short term Alloderm, albeit more resistant to infection than
plastic it is certainly not as resistant as natural tissue and when it
gets infected, it melts away. Jose Diaz up at Vanderbilt says he has
good luck in infected fields by treating the alloderm with sulfamylon
slurry until it granulates and then VACing over it. I've tried it but
haven't had good luck because every time I turn my back the residents
(or, sadly, one of my partners changes the regimen so I don't think I
ever gave it a real chance).

In terms of late weakening, I think it's very clear that Alloderm
stretches over time, The abdominal contents don't push past the edges
like a mesh failure but it essentially becomes a very expensive hernia
sac at 1-3 years. I've seen it a couple of times but Todd Heniford (big
hernia guy up at Carolinas Med) gave a grand rounds here last year and
he reported that it's almost universal if you use Alloderm to bridge a
gap rather than as a reinforcement.

I absolutely don't want to come off as if I'm putting myself out as
some sort of expert, btw. I'm sure other people have more experience.
This info is mostly second hand with oh, about 5-6 cases of massive
hernia with infection or ostomy where I didn't feel comfortable putting
in plastic. I tell the patients that we're probably going to have to do
a "proper" repair in a couple of years. And who knows, either I or they
may move out of town before that time!

Bill Bromberg

>>> "Marc Matthews - MedPro MMC X" <Marc_Matthews at medprodoctors.com>
1/3/2008 10:21 PM >>>
All,

Quick question . . . (As I just joined the website I am not sure if you
have discussed this topic before.)

Is anyone having problems with Alloderm for abdominal wall
reconstructions. We are having some recurrent hernias, infections, etc.
I am wondering if anyone is finding that it is not being incorporated
into the fascia and instead is just weakening over time. Patients are
returning to clinic with complaints of recurrent hernias months to years
out. I have placed it in several patients but stopped early on. I was
concerned but had no data at that time.

What is everyone else seeing and what are people's feelings about this
product and the porcine Surgisis product?

Thank you,

Marc R. Matthews, MD
Medical Director, Trauma Services, Maricopa Medical Center
Medical Director, Respiratory Care Services, Maricopa Medical Center
Associate Director, Arizona Burn Center, Maricopa Medical Center

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