AUTHOR=Schaaf Sebastian , Mones Thomas , Mai Peter , Hoedt Niels-Torsten , Götz Markus , Willms Arnulf , Woeste Guido 
  
TITLE=Selective use of reinforced tissue matrix in complex abdominal wall reconstruction: a multicenter consensus analysis
  
JOURNAL=Journal of Abdominal Wall Surgery
  
VOLUME=Volume 5 - 2026
  
YEAR=2026
  
URL=https://www.frontierspartnerships.org/journals/journal-of-abdominal-wall-surgery/articles/10.3389/jaws.2026.17323
  
DOI=10.3389/jaws.2026.17323
  
ISSN=2813-2092
  
ABSTRACT=BackgroundOptimal 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.MethodsA 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 ≥70% agreement, and interrater reliability was assessed using Fleiss’ kappa.ResultsSeventy-four patients were included (mean age 63.9 ± 12.0 years; median BMI 30.2 kg/m2). 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 (κ = 0.34).ConclusionRoutine 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.