COMPARISON OF NOVEL SYNTHETIC MATERIALS WITH TRADITIONAL METHODS TO REPAIR EXPOSED ABDOMINAL-WALL FASCIAL DEFECTS

Repair of large abdominal wall defects is a challenge, particularly wh en full-thickness tissue loss prohibits coverage of the fascial repair . Two novel synthetic materials (TMS-1 and TMS-2) have been shown to b e better accepted than expanded polytetrafluoroethylene (Gore-Tex), an d polypropylene (Marlex) in the closure of clean and contaminated fasc ial wounds that are immediately covered by skin/soft tissue. Therefore , 1-cm(2) abdominal wall defects were created in each of the four quad rants of rat groups. Gore-Tex, Marlex, and TMS-1 or TMS-2 were used to repair three defects, the fourth being primarily closed. To ensure th at each repair remained exposed, skin edges were sutured to underlying muscle. Additional animal groups underwent the same protocol; however , peritonitis was induced at surgery using a fecal inoculum technique. Animals were sacrificed 2 weeks later, at which time a blinded observ er assessed the surface area and severity of adhesions. In clean wound s, the surface area of formed adhesions was less (p < .004) after prim ary closure than each synthetic material; among the synthetics, TMS-2 caused significantly (p < .01) less extensive adhesions than Marlex. I n addition, the severity of adhesions to TMS-2 was comparable to that of defects closed primarily, and less severe (p < .02) than those form ed to Gore-Tex and Marlex. In animals with peritonitis, primary closur e caused less extensive (p < .03) adhesions than Marlex and Gore-Tex a nd significantly (p < .002) less severe adhesions than Marlex, Gore-Te x, and TMS-2. However, the severity of adhesions formed to TMS-1 repai rs proved comparable to primarily closed wounds. These experiments rea ffirm the tenet that, whenever possible, abdominal wounds should under go primary fascial closure. When soft tissue coverage over the repair cannot be achieved, TMS-2 is well tolerated in clean wounds. However, the superiority of TMS-1 over the other synthetic materials in contami nated wounds suggests it may also ultimately prove to be of clinical u tility.