Use of Absorbable Mesh in the Staged Repair of Contaminated Abdominal Wall Defects

  • Merril T. Dayton


Virtually every abdominal surgeon has faced the problem of closing a contaminated abdominal defect in which the fascia cannot be easily brought together primarily. Infected fascia may be inadequately debrided in the hope of leaving enough fascia for primary closure without tension, or, as observed by Stone et al, there may be an obsession with obtaining fascia-to-fascia approximation regardless of tension. Usually, however, the surgeon recognizes that closure of an extensively contaminated abdominal defect under tension virtually guarantees a return trip to the operating room to repair a fascial dehiscence. Whatever the circumstances, inadequate debridement of necrotic fascia, or fascia of questionable viability, is a violation of surgical principles.


Abdominal Wall Ventral Hernia Polypropylene Mesh Abdominal Wall Defect Spigelian Hernia 
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  1. 1.
    Stone HH, Fabian TC, Turkles ML, et al. Management of acute full-thickness losses of the abdominal wall. Ann Surg. 1981; 193:612–617.PubMedCrossRefGoogle Scholar
  2. 2.
    Dayton MT, Buchele BA, Shirazi SS, et al. Use of an absorbable mesh to repair contaminated abdominal wall defects. Arch Surg. 1986; 121: 954–960.PubMedCrossRefGoogle Scholar
  3. 3.
    Witzel O. Ueber die Verschliessung von Bauchwunden unter Brucht-pforten durch Versenkte Silverdrahtnetze. Cent Chir. 1900; 27:257.Google Scholar
  4. 4.
    Goepel R. Uber die Verschliessung von Bruchpforten durch einheilung Geflochtener Feriger Silberdrahtnetze. Verh Dtsch Ges Chir. 1900; 29:4.Google Scholar
  5. 5.
    Usher FC, Wallace SA. Tissue reaction to plastics: a comparison of nylon, Orion, Dacron, Teflon, and Marlex. Arch Surg. 1958; 76:997–999.CrossRefGoogle Scholar
  6. 6.
    Schmitt JH Jr, Grinnan GLB. Use of Marlex mesh in infected abdominal war wound. Am J Surg. 1967; 113:825–828.PubMedCrossRefGoogle Scholar
  7. 7.
    Eng K, Casson P, Berman IR, et al. Clostridial myonecrosis of the abdominal wall. Am J Surg. 1973; 125:367–371.PubMedCrossRefGoogle Scholar
  8. 8.
    Gilsdorf RB, Shea MM. Repair of massive septic abdominal wall defects with Marlex mesh. Am J Surg. 1975; 130:634–638.PubMedCrossRefGoogle Scholar
  9. 9.
    Wouters DB, Krom RAF, Slooff MJH, et al. The use of Marlex mesh in patients with generalized peritonitis and multiple organ system failure. Surg Gynecol Obstet. 1983; 156:609–614.PubMedGoogle Scholar
  10. 10.
    Boyd WC. Use of Marlex mesh in acute loss of the abdominal wall due to infection. Surg Gynecol Obstet. 1977; 144:251–252.PubMedGoogle Scholar
  11. 11.
    Voyles CR, Richardson JD, Bland KI, et al. Emergency abdominal wall reconstruction with polypropylene mesh. Ann Surg. 1981; 194:219–223.PubMedCrossRefGoogle Scholar
  12. 12.
    Jones JW, Jurkovich GJ. Polypropylene mesh closure of infected abdominal wounds. Am Surg. 1989; 55:73.PubMedGoogle Scholar
  13. 13.
    Delaney HM, Porreca F, Mitsudo S, Solanki B, Rudavsky A. Splenic capping: an experimental study of a new technique for splenorrhaphy using woven polyglycolic acid mesh. Ann Surg. 1982; 196:187.CrossRefGoogle Scholar
  14. 14.
    Lamb JP, Vitale T, Kaminskin DL. Comparative evaluation of synthetic meshes used for abdominal wall replacement. Surgery 1983; 93:643.PubMedGoogle Scholar
  15. 15.
    Jenkins SD, Klamer TW, Parteka JJ, et al. A comparison of prosthetic materials used to repair abdominal wall defects. Surgery. 1983; 94:392.PubMedGoogle Scholar
  16. 16.
    Tyrell J, Silberman H, Chandrasoma P, et al. Absorbable versus permanent mesh in abdominal operations. Surgery. 1989; 168:227–232.Google Scholar
  17. 17.
    Klinge U, Klosterhalfen B, Conze J, et al. Modified mesh for hernia repair that is adapted to the physiology of the abdominal wall. Eur J Surg. 1998; 164(12):951–960.PubMedCrossRefGoogle Scholar
  18. 18.
    Dasika UK, Widmann WD. Does lining polypropylene with polyglactin mesh reduce intraperitoneal adhesions? Am Surg. 1998; 64(9):817–820.PubMedGoogle Scholar
  19. 19.
    Zieren J, Castenholz E, Baumgart E, et al. Effects of fibrin glue and growth factors released from platelets on abdominal hernia repair with a resorbable PGA mesh: experimental study. J Surg Res. 1999; 85(2): 267–272.PubMedCrossRefGoogle Scholar
  20. 20.
    Klinge U, Klosterhalfen B, Muller M, et al. Influence of polyglactin-coating on functional and morphological parameters of polypropylenemesh modifications for abdominal wall repair. Biomaterials. 1999; 20(7):613–623.PubMedCrossRefGoogle Scholar
  21. 21.
    Delaney HM, Rudavsky A, Lan S. Preliminary clinical experience with the use of absorbable mesh splenorrhaphy. J Trauma. 1985; 25:909.CrossRefGoogle Scholar
  22. 22.
    Delaney HM, Solanki B, Driscoll WB. Use of absorbable mesh for splenorrhaphy and pelvic peritoneum reconstruction. Contemp Surg. 1985; 27:11.Google Scholar
  23. 23.
    McGahren ED, Rodgers BM, Waldron PE. Successful management of stage 4S neuroblastoma and severe hepatomegaly using absorbable mesh in an infant. J Pediatr Surg. 1998; 33(10):1554–1557.PubMedCrossRefGoogle Scholar
  24. 24.
    Smith PC, Tweddell JS, Bessey PQ. Alternative approaches to abdominal wound closure in severely injured patients with massive visceral edema. J Trauma. 1992; 32(1):16–20.PubMedCrossRefGoogle Scholar
  25. 25.
    Buck JR, Fath JJ, Chung SK, et al. Use of absorbable mesh as an aid in abdominal wall closure in the emergent setting. Am Surg. 1995; 61(8):655–658.PubMedGoogle Scholar
  26. 26.
    Gentile AT, Feliciano PD, Mullins RJ, et al. The utility of polyglycolic acid mesh for abdominal access in patients with necrotizing pancreatitis. J Am Coll Surg. 1998; 186(3):313–318.PubMedCrossRefGoogle Scholar
  27. 27.
    Chendrasekhar A. Bedside placement of polyglycolic acid mesh: a novel treatment of uncomplicated abdominal wound dehiscence. W V Med J. 1996; 92(3):136–137.PubMedGoogle Scholar
  28. 28.
    Fabian TC, Croce MA, Pritchard FE, et al. Planned ventral hernia. Staged management for acute abdominal wall defects. Ann Surg. 1994; 219(6):643–653.PubMedCrossRefGoogle Scholar
  29. 29.
    Greens MA, Mullins RJ, Malangoni MA, et al. Laparotomy wound closure with absorbable polyglycolic acid mesh. Surg Gynecol Obstet. 1993; 176(3):213–218.Google Scholar
  30. 30.
    Ramadwar RH, Carachi R, Young DG. Collagen-coated Vicryl mesh is not a suitable material for repair of diaphragmatic defects. J Pediatr Surg. 1997; 32(12):1708–1710.PubMedCrossRefGoogle Scholar
  31. 31.
    Carachi R, Audry G, Ranke A, et al. Collagen-coated Vicryl mesh: a new bioprosthesis in pediatric surgical practice. J Pediatr Surg. 1995; 30(9): 1302–1305.PubMedCrossRefGoogle Scholar
  32. 32.
    Barie PS, Thompson WA, Mack CA. Planned laparoscopic repair of a spigelian hernia using a composite prosthesis. J Laparoendosc Surg. 1994; 4(5):359–363.PubMedCrossRefGoogle Scholar
  33. 33.
    Porter JM. A combination of Vicryl and Marlex mesh: a technique for abdominal wall closure in difficult cases. J Trauma. 1995; 39(6): 1178–1180.PubMedCrossRefGoogle Scholar
  34. 34.
    Alponat A, Lakshminarasappa SR, Yavuz N, et al. Prevention of adhesion by Seprafilm, an absorbable adhesion barrier: an incisional hernia model in rats. Am Surg. 1997; 63(9):818–819.PubMedGoogle Scholar
  35. 35.
    Edlich RF, Panek PH, Rodeheaver GT, et al. Physical and chemical configuration of sutures in the development of surgical infection. Ann Surg. 1997; 177:679–687.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Merril T. Dayton
    • 1
  1. 1.Department of SurgeryUniversity of UtahSalt Lake CityUSA

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