Microbiology of infected acellular dermal matrix (AlloDerm) in patients requiring complex abdominal closure after emergency surgery

Samir S. Awad, Raghuram K. Rao, David H. Berger, Daniel Albo, Charles F. Bellows

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Acellular dermal matrix (AlloDerm) has recently been introduced as an option for complex abdominal closure for patients with loss of abdominal wall domain secondary to intra-abdominal sepsis or necrotizing fasciitis. AlloDerm has been touted as a promoter of neovascularization and collagen deposition. Currently, the rate of AlloDerm infection in contaminated cases is unknown. Our objective was to determine if the organisms cultured during source control would infect AlloDerm. Methods: The medical records of patients who required complex abdominal closure with AlloDerm in a tertiary-care hospital were reviewed from January to December, 2005. For each patient demographic, the reason for urgent surgery, American Society of Anesthesiologists (ASA) class, Acute Physiology and Chronic Health Evaluation (APACHE) II score, serum albumin concentration, culture results of purulent fluid obtained during surgery, and culture results of biopsies of infected-appearing AlloDerm (change of color, delayed granulation, odor) were collected. Data are presented as mean ± standard error of the mean. Results: Seventeen patients required the use of AlloDerm for tension-free closure of the abdominal wall after surgery for source control in necrotizing fasciitis (13%) or intra-abdominal sepsis (87%). The mean age was 61 ± 2 years; 73% of the patients were Caucasian, the remainder being African American. The mean APACHE II score was 23.7 ± 2.0, and the median ASA class was 3. The mean preoperative albumin concentration was 2.27 ± 0.26 g/dL. Most (76%) of the patients had a wound vacuum-assisted closure system placed over the AlloDerm. Four patients (24%) were noted to have an infection of the AlloDerm graft at 24 ± 10 days postoperatively. The cultures obtained at operation and from infected AlloDerm show similar organisms (Pseudomonas in two, Escherichia coli and methicillin-resistant Staphylococcus aureus in one each). Infected AlloDerm was coated with silver sulfadiazene and moistened dressings, and all four patients had complete resolution of the Allo-Derm infection with an adequate bed of granulation tissue, allowing skin grafting. Conclusion: Patients with contaminated abdomens who require complex closure with AlloDerm are at risk of developing infection of their graft material with organisms similar to those present at the time of surgery. Once culture results are obtained, topical antimicrobials with activity against the cultured organisms may be employed as part of the AlloDerm dressings to prevent infection and promote healing.

Original languageEnglish (US)
Pages (from-to)79-84
Number of pages6
JournalSurgical Infections
Volume10
Issue number1
DOIs
StatePublished - Dec 1 2009
Externally publishedYes

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Acellular Dermis
Microbiology
Emergencies
Necrotizing Fasciitis
Infection
APACHE
Abdominal Wall
Bandages
Alloderm
Sepsis
Negative-Pressure Wound Therapy
Transplants
Skin Transplantation
Granulation Tissue
Tertiary Healthcare
Methicillin-Resistant Staphylococcus aureus
Pseudomonas
Silver
Tertiary Care Centers
Serum Albumin

ASJC Scopus subject areas

  • Surgery
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Microbiology of infected acellular dermal matrix (AlloDerm) in patients requiring complex abdominal closure after emergency surgery. / Awad, Samir S.; Rao, Raghuram K.; Berger, David H.; Albo, Daniel; Bellows, Charles F.

In: Surgical Infections, Vol. 10, No. 1, 01.12.2009, p. 79-84.

Research output: Contribution to journalArticle

Awad, Samir S. ; Rao, Raghuram K. ; Berger, David H. ; Albo, Daniel ; Bellows, Charles F. / Microbiology of infected acellular dermal matrix (AlloDerm) in patients requiring complex abdominal closure after emergency surgery. In: Surgical Infections. 2009 ; Vol. 10, No. 1. pp. 79-84.
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abstract = "Background: Acellular dermal matrix (AlloDerm) has recently been introduced as an option for complex abdominal closure for patients with loss of abdominal wall domain secondary to intra-abdominal sepsis or necrotizing fasciitis. AlloDerm has been touted as a promoter of neovascularization and collagen deposition. Currently, the rate of AlloDerm infection in contaminated cases is unknown. Our objective was to determine if the organisms cultured during source control would infect AlloDerm. Methods: The medical records of patients who required complex abdominal closure with AlloDerm in a tertiary-care hospital were reviewed from January to December, 2005. For each patient demographic, the reason for urgent surgery, American Society of Anesthesiologists (ASA) class, Acute Physiology and Chronic Health Evaluation (APACHE) II score, serum albumin concentration, culture results of purulent fluid obtained during surgery, and culture results of biopsies of infected-appearing AlloDerm (change of color, delayed granulation, odor) were collected. Data are presented as mean ± standard error of the mean. Results: Seventeen patients required the use of AlloDerm for tension-free closure of the abdominal wall after surgery for source control in necrotizing fasciitis (13{\%}) or intra-abdominal sepsis (87{\%}). The mean age was 61 ± 2 years; 73{\%} of the patients were Caucasian, the remainder being African American. The mean APACHE II score was 23.7 ± 2.0, and the median ASA class was 3. The mean preoperative albumin concentration was 2.27 ± 0.26 g/dL. Most (76{\%}) of the patients had a wound vacuum-assisted closure system placed over the AlloDerm. Four patients (24{\%}) were noted to have an infection of the AlloDerm graft at 24 ± 10 days postoperatively. The cultures obtained at operation and from infected AlloDerm show similar organisms (Pseudomonas in two, Escherichia coli and methicillin-resistant Staphylococcus aureus in one each). Infected AlloDerm was coated with silver sulfadiazene and moistened dressings, and all four patients had complete resolution of the Allo-Derm infection with an adequate bed of granulation tissue, allowing skin grafting. Conclusion: Patients with contaminated abdomens who require complex closure with AlloDerm are at risk of developing infection of their graft material with organisms similar to those present at the time of surgery. Once culture results are obtained, topical antimicrobials with activity against the cultured organisms may be employed as part of the AlloDerm dressings to prevent infection and promote healing.",
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