Laparotomy wound closure with absorbable polyglycolic acid mesh.
A knitted mesh of polyglycolic acid was used successfully in 59 critically ill patients to bridge abdominal wall defects and prevent evisceration after celiotomy. Polyglycolic acid knit mesh was used in 31 patients who had extraordinary visceral edema after resuscitation and the mesh was inserted to avoid excessive tension in the wound closure, 15 patients who had abdominal wall defects after adequate débridement for necrotizing fasciitis, and 13 patients who had losses of abdominal wall tissue caused by trauma or after resection of tumor. There were 14 hospital deaths among the seriously ill patients. Thirteen patients had enterocutaneous fistulas, seven of which occurred after meshes were inserted. The mesh material was strong, pliable and easily inserted in large abdominal wall defects. The polyglycolic acid knit mesh was infiltrated by granulation tissue within three weeks, including in heavily contaminated wounds. Two to three months after insertion, the material was absorbed. Hernia defects were common four to six months after the meshes were inserted and repairs were performed electively after patients had recovered from the primary problems. We conclude that absorbable polyglycolic acid knit mesh can be a useful technique for quickly achieving a secure tension-free closure of abdominal wounds.
Greene
M A
MA
Oregon Health Sciences University, Department of Surgery, Portland 97201-3098.
Mullins
R J
RJ
Malangoni
M A
MA
Feliciano
P D
PD
Richardson
J D
JD
Polk
H C
HC
D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods*; D011100:Polyglycolic Acid; D013526:Surgical Mesh / Q000009:adverse effects; D013536:Suture Techniques
D011100:Polyglycolic Acid