Background: The ideal technique for the use of AlloDerm (LifeCell Corp) in complicated ventral hernia repair has not been defined. The expense of these products mandates careful evaluation to justify their widespread use. We compared two techniques of fascial bridging versus fascial reinforcement repair with regard to their longterm recurrence rates using AlloDerm. Study Design: We retrospectively studied patients with abdominal defects repaired with AlloDerm at our institution. Results: Thirty-seven patients with abdominal wall repairs using AlloDerm were identified between January 2004 and December 2005. Eleven patients underwent bridged fascial repair; 26 patients had reinforced fascial repair. There was no statistical significance between the 2 groups in terms of average age (57 versus 52 years), body mass index (35 versus 29 kg/m2), American Society of Anesthesiologists score (2.9 versus 2.5), or number of earlier abdominal operations (3.4 versus 3.5). The average sizes of AlloDerm used were 175 cm2 for bridged and 89 cm2 for reinforced repair (p = 0.005). In patients with reinforced closure, primary repair was achieved with lateral component separation in 22 of 26 patients. Mean followup was 21.4 months (range 15 to 36 months). In the bridged group, 1 patient died on postoperative day 20. Of the remaining 10 patients, 8 patients (80%) developed recurrences. Seven patients required reoperation, but one patient refused repair. In the reinforced group, four patients were lost to followup and two patients died. Four of the remaining 20 patients (20%) developed recurrences that required repair; this was significantly different from the recurrence rate in the bridged group (p = 0.009). Conclusions: This study demonstrated that the method in which AlloDerm is used in abdominal wall reconstruction has a significant impact on recurrence rates. Based on our findings, AlloDerm should be used only as a reinforcement after primary fascial reappoximation.