Ventral hernias are complex because of different factors including the presence of local infection, size of the defect, obesity, and the unusual location away from the common midline hernias. To compare ventral hernias in the face of infection, we must use the appropriate classification. Currently, the widely accepted classification scheme is the modified ventral hernia classification with three grades [1]. Group A is clean hernias. Group B consists of patients on immunosuppressive medications, obese patients, immunocompromised patients, diabetics, patients with COPD or a history of wound infection or infected mesh. Group C is patients with clean contaminated, contaminated or dirty wounds [1]. For the Group A patients, the use of synthetic mesh is considered appropriate. For Group B, there is a debate between the use of synthetic mesh or biologic mesh. For the infected Group C hernias, the placement of absorbable (biologic meshes) is considered standard of care, despite some recent data that has shown that large pore low-weight synthetic meshes could be acceptable. The high cost of these biologic meshes and their rapid degradation have allowed a new category of meshes to establish themselves as an elegant alternative: biosynthetic meshes represented by Phasix? (Bard; Murray Hill, New Jersey) [2, 3] and also Bio A (Gore; Flagstaff, Arizona) [4] have taken the market by storm.
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