Incision choice for complicated ventral hernia patients an OVIO 360 degree photo comparison: a case report

Background: The senior authors have previously published on abdominal wall reconstruction using Strattice acellular dermal matrix demonstrating effective aesthetic and functional results. As our experience increases, we are often faced with more challenging hernias as well as more complex patients. Purpose: To demonstrate a simple incision pattern that can be used in complex medical patients and patients with a high body mass index. Methods: A retrospective chart review was performed on our patient who underwent an abdominal wall reconstruction of a ventral incisional hernia with component separation and placement of Strattice acellular dermal matrix. The patient is a tall male with a high body mass index and a history of cirrhosis complicated by ascites. Results: Strattice acellular dermal matrix was successfully used in an underlay fashion to reinforce a midline hernia repair. A vertical and horizontal cross-four pronged star incision was used to gain access to the abdominal wall to preserve the venous drainage of the superficial epigastric and circumflex systems. These are often dominant arterial and venous angiosomes of the abdominal wall and offer the benefit of dependent venous drainage. Conclusion: Successful repairs of primary and recurrent abdominal hernias with Strattice acellular dermal matrix are effective. Based on our experience, for patients with a high body mass index who are at increased risk of seroma formation and skin necrosis, utilizing a combined vertical and horizontal cross incision for exposure can help minimize complications and optimize aesthetic outcomes.