Synthetic graft placement in the treatment of fascial dehiscence with necrosis and infection

OBJECTIVE: The objective of this study was to describe the use of synthetic grafts in repairing fascial dehiscence complicated by fascial necrosis and infection after obstetric and gynecologic operations. STUDY DESIGN: A retrospective review of the operating room records at Hutze l Hospital (Detroit, Mich) was performed to find all cases of fascial dehis cence repaired during a B-year period between January 1, 1991, and December 31, 1996. Patients with partial or complete disruption of the fascia with evidence of fascial necrosis and infection were included in this study. Dem ographic information; the initial surgical procedure, including type of inc ision; suture material; use of synthetic graft and closure technique for re pair of dehiscence; postoperative complications, microbiologic results; ant ibiotic therapy; subsequent operations; length of hospital stay; and late c omplications were recorded. RESULTS: During the study period 52 patients underwent repair of fascial de hiscence; 36 of these had concurrent fascial necrosis and infection, includ ing 4 women with necrotizing fasciitis. Eighteen patients were from the obs tetric service and 18 were from the benign or cancer gynecology service. Ni nety-one bacterial isolates were recovered from the infected wounds. Extens ive fascial resection precluded closure without tension in 18 cases and nec essitated synthetic graft placement to prevent evisceration. Graft material s included polypropylene (11 cases) and polyglactin (7 cases). Late complic ations of graft placement included extrusion of the graft in 3 patients and incisional hernia in 1. CONCLUSIONS: Extensive fascial debridement with resection prevents primary closure of wound dehiscence. Synthetic grafts permit primary closure of lar ge fascial defects and can be used with extensive debridement in the presen ce of infection.