Larger hernias of the abdominal wall require that the muscles of the abdominal wall be put back into their normal anatomic position. The muscles often affected by previous complex abdominal operations are the rectus abdominis, the external oblique, the internal oblique, and the transversus abdominis. These muscles can be affected by previous incisions such as subcostal incisions for hepatic, pancreatic, or splenic resections. Restoring a dynamic abdominal wall is helpful to prevent hernia recurrence. The repair of these muscles can be reconstructed with a load sharing principle by placing an acellular dermal matrix posterior to the abdominal wall musculature. A common acellular dermal matrix used is Strattice. This is a porcine (pig) dermis that has the epidermis removed. This provides a tough durable matrix to facilitate abdominal wall closure and maintain a dynamic abdominal wall.
