USE OF ABSORBABLE MESH AS AN AID IN ABDOMINAL-WALL CLOSURE IN THE EMERGENT SETTING

A surgeon has many options available to aid in the closure of abdomina l wall defects in the elective setting. In the emergent setting, activ e infection or contamination increases the likelihood of infection of permanent prosthetic material and limits the surgical options. In such settings, we have used absorbable mesh (Dexon(R)) as an adjunct to fa scial closure until the acute complications resolve. To evaluate the e ffectiveness of this technique, we reviewed the outcome of such closur es in 26 critically ill patients. Between July 1987 and June 1993, 26 patients were identified who had placement of absorbable mesh as part of an emergent laparotomy at a major urban trauma center. Through a re trospective chart review, the incidence of complications and outcome o f the closure were tabulated. Seven patients were initially operated o n for trauma. Two of the patients had mesh placement at their initial procedure secondary to fascial loss from trauma. The remainder of the patients had mesh placement during a subsequent laparotomy for complic ations related to their initial procedure. Indications for these lapar otomies included combinations of wound dehiscence, intra-abdominal abs cess, anastomotic disruption, and perforation. Mesh placement in patie nts with intra-abdominal infection created effectively open abdominal wounds that allowed continued abdominal drainage, but required extensi ve wound care. Despite the absorbable nature of the mesh and often pro longed hospital stay in these ill patients, none of them required reop eration for dehiscence, recurrence of intra-abdominal abscess, or infe ction of the mesh. Seven patients died. In survivors, wound healing wa s by secondary intent, split thickness skin graft, or mobilization of full thickness skin to the midline. Seventeen of 19 survivors had thei r mesh placed ventrally, and all of those who returned for followup ha d evidence of incisional hernia, which was dealt with electively.