This work aims to comprehensively evaluate patient assessment and explore avenues to improve outcomes for patients undergoing contaminated abdominal wall reconstruction (CAWR). A systematic review was performed to establish current outcomes from CAWR. Evaluation of national Hospital Episode Statistics data demonstrated contamination is a key risk factor for hernia recurrence (HR) justifying evaluation in isolation from clean defects.

Risk factors for the development of CAW defects were evaluated using national and local data. Factors including comorbidity, increasing BMI, emergency surgery and number of previous operations were found to be significant.

The use of two component separation techniques were evaluated using a systematic review and meta-analysis and found to be comparable across a range of outcomes.

Risk stratification was performed through development of logistic regression models evaluating surgical outcomes. Via international collaboration, a cohort of patients from 2004-2015 undergoing CAWR was used to develop the models. An independent cohort, from 2016-2017, was then evaluated to validate the models.

The use of CT-scanning in the evaluation of the CAW was investigated. After standardising measurement techniques, factors associated with surgical outcomes were assessed. Measurements related to hernia dimension are linked to long-term outcomes, such as HR.

Systematic review data demonstrated HR after using biologic mesh remained high, therefore a novel biologic mesh scaffold, using porcine AW tissue, was explored. A protocol for decellularisation was developed and tested for residual strength and pro-inflammatory proteins. The scaffold was then tested for in vivo biocompatibility demonstrating a significant increase in scaffold integration and a decrease in inflammatory reaction over 12-weeks, supporting the conclusion that the scaffold shows promise as a future biomaterial.

Overall, this work has offered an evaluation of risk prior to the development of contaminated defects, helped the surgeon in decision-making and counselling patients for CAWR and investigated novel avenues for future reconstruction.