In April of 1998, this Journal published the article “Restoring Abdominal Wall Integrity in Contaminated Tissue-Deficient Wounds using Autologous Fascia Grafts.”1 The purpose of that study was to examine the clinical utility of autologous fascia lata grafts for abdominal wall reconstruction where local tissue is inadequate and where prosthetic material is contraindicated. Autologous fascial grafts had already been shown to become vascularized and to resist infection compared with synthetic mesh in a rabbit model.2 Thirty-two patients underwent abdominal reconstructions using autologous fascia lata grafts during a 9-year period. The majority were patients with ventral hernias who had exposed synthetic mesh, enteric fistulas, or wound contamination. The mean follow-up period was 27 months (range, 3 to 106 months), with a hernia recurrence rate of 9 percent (three patients). Based on the early success with the above series of patients, the indications for using autologous fascia lata have now widened to include not only those patients in whom prosthetic material is absolutely contraindicated but also those patients who may be at increased risk for infections. The majority of patients in this new category are solidorgan transplant recipients who are chronically immunosuppressed. Those immunosuppressed patients who developed incisional hernias are now treated primarily with autologous fascia lata grafts. There are currently 81 patients in the series with an overall recurrence rate of 29 percent. This increase in hernia recurrence is due in part to a longer follow-up period and in part to an increase in the percentage of patients in the series with multiple recurrent hernias and with chronic immunosuppression. This hernia recurrence rate is within an acceptable range for this group of extremely challenging patients. Fascia lata grafts certainly are a major improvement over previous standard methods of bringing autologous tissue to the abdominal wall, such as large pedicled flaps like the rectus femoris flap, tensor fasciae latae flap, or latissimus dorsi flap. One major advantage of these grafts is that, unlike with synthetic mesh, the grafts do not have to be removed in cases of wound infection or wound breakdown with graft exposure. The major drawback of fascia lata grafts, however, is that they exist in a limited and easily exhaustible supply, and they can result in donor-site morbidities such as pain, seroma, and delayed ambulation. Recent efforts in our research laboratory have focused on using acellular dermal matrix (AlloDerm, LifeCell Corporation, Branchburg, N.J.) for abdominal wall reconstruction. An initial feasibility study tested the AlloDerm for ventral hernia repair in a rabbit model to see whether it would revascularize in the abdominal wall.3 Abdominal wall defects were created in 25 rabbits and repaired with AlloDerm (group A; n 10), Micromesh [W. L. Gore and Associates, Inc., Elkton, Md. (group B; n 10)], and primary closure