ADVANTAGES OF AUTOLOGOUS FASCIA VERSUS SYNTHETIC PATCH ABDOMINAL RECONSTRUCTION IN EXPERIMENTAL ANIMAL DEFECTS

Although prosthetic patches (i.e., expanded polytetrafluoroethylene) a re commonly used to repair abdominal fascial defects, autologous tissu e is preferred in the presence of wound contamination. This study was undertaken to discover (1) whether fascial grafts are revascularized a nd incorporated as living tissue, and (2) whether ir fascial grafts ar e more resistant to bacterial contamination than prosthetic patches. I n the first experiment, 18 New Zealand White rabbits underwent full-th ickness resection of the central abdominal wall preserving only pannic ulus carnosus and skin. Six control animals had only skin repaired, an d all developed large ventral hernias. Twelve animals had the defect r epaired with thoracodorsal fascia patches. At 3- and 6-week intervals, no hernias were present and all patches were incorporated with minima l contraction. Fluorescein angiography verified revascularization from the surrounding abdominal wall. Next, 36 rabbits underwent similar re section followed by repair with either autologous fascia (n = 18) or e xpanded polytetrafluoroethylene (n = 17). Six rabbits of each repair; group were inoculated with 10(4) Staphylococcus aureus and twelve rabb its with each repair were inoculated with 10(9) S. aureus. All rabbits receiving 10(4) S. aureus were infection-free survivors. Seven of the twelve expanded polytetrafluoroethylene-repaired animals receiving 10 (9) S. aureus developed necrotizing wound infections and died. Only 2 of 12 rabbits with autologous fascia repairs died from wound sepsis an d 1 died of diarrhea with a healed wound. Differences in wound infecti on rates achieved statistical significance, whereas survival differenc es approached signif icance (Fisher's exact test), suggesting that rev ascularized fascial grafts may be more resistant to bacterial contamin ation than expanded polytetrafluoroethylene patches at this concentrat ion (10(9) S. aureus).