{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T06:00:48Z","timestamp":1790056848668,"version":"4.0.1"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontierspartnerships.org"],"crossmark-restriction":true},"short-container-title":["J. Abdom. Wall Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Optimal mesh selection in complex abdominal wall reconstruction remains controversial, particularly in contaminated fields or in patients with extensive tissue loss. Reinforced tissue matrix (RTM) meshes combine biologic material with permanent synthetic reinforcement and may represent a potential option in selected cases. This study aimed to analyze clinical use patterns of RTM meshes and identify potential indication niches through structured expert consensus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A multicenter expert panel collected cases of abdominal wall reconstruction using RTM mesh (OviTex). Patient characteristics, hernia features, operative strategies, and postoperative outcomes were recorded in a standardized database. Cases were evaluated according to established complexity criteria. Seven abdominal wall surgeons independently rated the appropriateness of RTM use. Consensus was defined as \u226570% agreement, and interrater reliability was assessed using Fleiss\u2019 kappa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventy-four patients were included (mean age 63.9 \u00b1 12.0 years; median BMI 30.2\u00a0kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ). Most patients presented with incisional hernias and large fascial defects. Contaminated or potentially contaminated operative fields were present in approximately one-third of cases. Surgical site infection occurred in 20.3%, mesh infection in 7.8%, and hernia recurrence in 12.3%. Expert consensus supporting RTM implantation was reached in 50% of cases, particularly in scenarios combining contamination with large fascial defects. Interrater agreement was fair (\u03ba = 0.34).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Routine use of RTM meshes in abdominal wall reconstruction is not supported. However, RTM may represent a potential option in selected high-complexity scenarios involving contamination and large fascial defects where permanent synthetic meshes may be unsuitable. These findings are exploratory and hypothesis-generating and may support future Delphi-based indication consensus development.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/jaws.2026.17323","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T05:10:20Z","timestamp":1790053820000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Selective use of reinforced tissue matrix in complex abdominal wall reconstruction: a multicenter consensus analysis"],"prefix":"10.3389","volume":"5","author":[{"given":"Sebastian","family":"Schaaf","sequence":"first","affiliation":[{"name":"Bundeswehrzentralkrankenhaus Koblenz, Department of General, Visceral and Thoracic Surgery","place":["Koblenz, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Mones","sequence":"additional","affiliation":[{"name":"St\u00e4dtisches Krankenhaus Maria-Hilf Brilon gGmbH","place":["Brilon, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Mai","sequence":"additional","affiliation":[{"name":"Barmherzige Br\u00fcder Krankenhaus M\u00fcnchen","place":["Munich, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels-Torsten","family":"Hoedt","sequence":"additional","affiliation":[{"name":"Evangelisches Diakonissenhaus","place":["Leipzig, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"G\u00f6tz","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsklinikum Regensburg","place":["Regensburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnulf","family":"Willms","sequence":"additional","affiliation":[{"name":"Bundeswehrzentralkrankenhaus Koblenz, Department of General, Visceral and Thoracic Surgery","place":["Koblenz, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Woeste","sequence":"additional","affiliation":[{"name":"Agaplesion Elisabethenstift gGmbH","place":["Darmstadt, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"znad346","DOI":"10.1093\/bjs\/znad346","article-title":"What defines an incisional hernia as 'complex': results from a Delphi consensus endorsed by the european hernia society (EHS)","volume":"111","author":"Capoccia Giovannini","year":"2024","journal-title":"Br J Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1732","DOI":"10.1093\/bjs\/znad284","article-title":"Midline incisional hernia guidelines: the european hernia society","volume":"110","author":"Sanders","year":"2023","journal-title":"Br J 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