Emergency Abdominal Wall Reconstruction with Polypropylene Mesh

Abstract

The acute replacement of full-thickness abdominal wall was facilitated by polypropylene mesh (Marlex) (PPM), allowing debridement of nonviable tissue and restoration of abdominal wall integrity without tension. No substantial long-term follow-up was reported on the definitive wound coverage after the use of PPM in open wounds. Since 1976, PPM were placed in 31 patients; 25 for infectious complication; 3 for massive bowel distension preventing abdominal closure and 3 for shotgun wounds with extensive tissue loss. In 29 of 31 patients, the mesh was placed in heavily contaminated wounds; extensive fasciitis was present in 23 patients and 21 had intraabdominal abscesses. Following mesh placement, 23 reoperations were required for continuing complications. No patients eviscerated, despite these multiple procedures. Polypropylene mesh was highly effective in restoring abdominal wall continuity. Despite advantages when PPM was used, significant long-term problems developed. Seven patients died from their primary illness in the postoperative period. Nine wounds were closed by granulation and subsequent split-thickness skin grafts. All 9 developed mesh extrusion and/or enteric fistulae. Nine wounds healed by secondary intention, 6 developed enteric fistulae or continuing mesh extrusion. Full-thickness flap coverage after granulation provided the best means of wound closure. Polypropylene mesh had significant early advantages for providing abdominal wall integrity even in the presence of severe infection. Long-term problems were common when wounds were closed to skin grafts or secondary intention. If the mesh cannot be completely removed, strong consideration should be given to myocutaneous flaps for coverage after the primary illness has resolved.