Polypropylene mesh closure of infected abdominal wounds

The management of extensive abdominal tissue loss in the presence of intraabdominal infection or wound dehiscence challenges the surgeon's ingenuity in wound care. Radical debridement and primary fascial closure may be impossible due to tissue loss or extensive bowel edema. The use of a synthetic mesh to bridge the fascial defect and maintain the integrity of the abdominal cavity may initially appear to be an attractive alternative to simply leaving the viscera exposed. However, this report and review of the literature document the frequent complications and high morbidity associated with this technique. An overall complication rate approaching 80% can be anticipated if polypropylene mesh is used in this emergency situation. Two modifications of wound care appear to markedly diminish the incidence of serious complications. Covering the mesh with full-thickness skin or muscle flaps in the early postoperative period, or removing the mesh at the earliest time conducive to fascial closure (within 2 weeks) reduced the overall complication rate from 55% to 15% in this review. However, it is often impossible to predict which patients will be amenable to early mesh removal, and full-thickness coverage of a persistently infected wound is usually doomed to failure. Despite the occasional usefulness of these modifications, this review suggests that polypropylene mesh in the emergency setting has an unacceptably high complication rate, and alternative methods of wound care in these complex situations should be considered.