POLYPROPYLENE MESH CLOSURE OF THE COMPLICATED ABDOMINAL WOUND

BACKGROUND: Closure of the abdominal wall in the face of fascial necro sis or massive intestinal edema remains a difficult problem with frequ ent complications, Prior studies have addressed both the utility and t he pitfalls of placing polypropylene mesh in this setting. METHODS: We performed a retrospective evaluation of our experience with polypropy lene mesh in traumatic and nontraumatic difficult abdominal closures, Timing of mesh placement and removal relative to the initial operation were recorded, as were abdominal complications, number of operative p rocedures, and type of ultimate abdominal closure, RESULTS: Between 19 88 and 1993, polypropylene mesh was placed in 26 critically ill or inj ured patients requiring celiotomy, of whom 23 survived more than 3 wee ks, Ultimate wound management was delayed mesh removal and primary clo sure (17%), myocutaneous flap coverage over mesh (4%), split-thickness skin grafting to the granulating wound (35%), or closure by secondary intention over mesh (43%), Split-thickness skin grafting and closure by secondary intention resulted in enterocutaneous fistulas in 50% and 40% of cases, respectively, Full-thickness closure with or without me sh removal resulted in no fistulas, CONCLUSION: Mesh provided adequate fascial closure, even with gross wound contamination. Coverage of pol ypropylene mesh by secondary intention or split-thickness skin graftin g resulted in unacceptably high rates of fistulous complications, and this procedure should be replaced by either mesh removal or full-thick ness coverage,