Introduction: We would like to present a novel use of AlloDerm and free fascia lata graft for abdominal wall reconstruction in a case of complicated recurrent ventral hernia repair. Ventral hernias are a common surgical problem with high recurrence rates. The usual method of repair involves a synthetic prosthesis, which is suboptimal for patients who are immunocompromised, have an enterocutaneous fistula, have had a recent intra-abdominal infection, or have intra-operative enterotomies. They can develop wound infections necessitating removal of the synthetic material. Autologous fascial grafts become vascularized and resist infection better than synthetic mesh. However, fascia lata has a limited supply and thigh donor site morbidity.

Case: MC is a 57-year-old man with a history of multiple enterocutaneous fistulae and hernia repairs. On 1/26/2002 he underwent repair of his recurrent ventral hernia. During laparotomy, enterotomies were made. The defect measured 20 by 30 cm. A component separation was first performed by incising the external oblique fascia lateral to the rectus muscles and medially advancing the rectus muscles bilaterally. We harvested the fascia lata from his thigh and sutured it to the abdominal fascial edges. This did not close the entire length of the wound. The remaining defect was 5 by 7 cm. A sheet of AlloDerm was sutured directly to the edge of the fascia lata graft and to the remaining abdominal fascial edges. On 2/19/2002, he was readmitted with purulent drainage from his umbilicus. A CT scan showed an intra-abdominal abscess. The AlloDerm was not removed, and he was treated with percutaneous drainage and IV antibiotics. He is now healed without signs of infection or hernia recurrence.

Discussion: AlloDerm is an acellular dermal matrix processed from human cadaver skin. It is efficacious in the treatment of burns, for oral resurfacing, as soft-tissue filler, and for dural replacement. In a rabbit ventral hernia model, AlloDerm revascularizes and maintains functional integrity for 30 days. AlloDerm has no donor site morbidity and is readily available. We believe this is the first report of free fascia lata graft sutured to AlloDerm for abdominal wall reconstruction.