The omentum-polypropylene sandwich technique: an attractive method to repair large abdominal-wall defects in the presence of contamination or infection.
BACKGROUND
Repair of abdominal wall defects in the presence of contamination or infection continues to be a significant problem for surgeons. The loss of tissue warrants reinforcement of the abdominal wall, preferably by autologous material. However, autologous repair often requires extensive operations that carry a high morbidity. Moreover, the lack of sufficient fascia may be so extensive that insertion of a prosthetic material is inevitable. Polypropylene (PP) is the most appropriate material to use under these circumstances, but without coverage, the mesh will wrinkle and ultimately be extruded. The present report describes an alternative technique for repair of heavily contaminated abdominal-wall defects.


METHODS
Two patients with a very large heavily contaminated abdominal wall defect due to necrotizing fasciitis in one patient and a lion's bite in the other were treated with the omental sandwich technique. After radical debridement, resulting in a full thickness loss of the abdominal wall, the peritoneum was restored using absorbable polyglactin mesh. The fascial defect was bridged with a PP mesh that was fixed to the adjacent myoaponeurosis and covered with a pedicled omental flap. In both patients the omentum was covered with a split skin.


RESULTS
Wound healing in both patients was without complications. Both patients had a sufficient abdominal wall, without signs of herniation after a follow up of 4 and 30 months, respectively.


CONCLUSIONS
The omental sandwich technique is an attractive method to repair large abdominal wall defects in the presence of contamination or overt infection.
Bleichrodt
R P
RP
Department of Surgery, Radboud University Nijmegen Medical Center, Huispost 690, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. r.bleichrodt@chir.umcn.nl
Malyar
A W
AW
de Vries Reilingh
T S
TS
Buyne
O
O
Bonenkamp
J J
JJ
van Goor
H
H
D000328:Adult; D000369:Aged, 80 and over; D000818:Animals; D001733:Bites and Stings / Q000150:complications; D019115:Fasciitis, Necrotizing / Q000150:complications; D005260:Female; D046449:Hernia, Abdominal / Q000150:complications / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D008045:Lions; D008297:Male; D009852:Omentum / Q000601:surgery*; D011126:Polypropylenes; D019919:Prosthesis Implantation / Q000379:methods*; D013526:Surgical Mesh; D013536:Suture Techniques
D011126:Polypropylenes