INFECTIOUS SEQUELAE IN THE USE OF POLYGLYCOLIC ACID MESH FOR SPLENIC SALVAGE WITH INTRAPERITONEAL CONTAMINATION

Salvage of the injured spleen is important in the trauma patient. Loss of the spleen can result in both early and late infectious complicati ons due to immunologic and phagocytic deficits. Splenic salvage techni ques include the use of polyglycolic acid (PGA) mesh to wrap and tampo nade the damaged and bleeding spleen. However, the use of mesh may inc rease the incidence of infection in the presence of intraperitoneal co ntamination. We examined whether mesh in the contaminated field increa ses the infection rate compared to splenectomy in a murine model. Sixt y male Sprague-Dawley rats were divided into three groups of 20 each: splenectomy, splenic wrap with PGA, and control (with splenic mobiliza tion). AU rats were subjected to a standard inoculum of enteric bacter ia at the time of celiotomy. Sixteen (80%) of the splenectomy rats, 10 (50%) of the PGA mesh wrapped rats, and four (20%) of the control rat s expired (P < 0.5). In surviving rats, necropsy at 7 days demonstrate d abscess formation in all four (100%) of splenectomy, four of 10 (40% ) in PG;A mesh wrapped, and two of 16 (13%) of control rats. All of th e abscesses in the wrap group involved the mesh. Overall infection rat es (including fatal peritonitis, abscess formation, and empyema) were 100% for splenectomy, 75% for PGA mesh wrapped, and 30% for control ra ts (P < 0.05). We conclude in this experimental model that the use of PGA mesh wrap does increase susceptibility to infection, but much less so than splenectomy in the presence of intraperitoneal contamination. (C) 1996 Academic Press, Inc.