Osseous and chondral fixation of polypropylene mesh

Fixation of polypropylene (Marlex) mesh in the epigastrium and at the iliac crest can be ineffective because of insufficient local fascia; however, two techniques have been described to obtain firm and durable attachment of polypropylene grafts at these sites. Perichondral slips at the costal margin permit very satisfactory attachment with excellent long-term results. Stainless steel wire fixation of the mesh to the iliac crest has satisfied the need for osseous fixation in that area. Long-term repair of difficult and recurrent hernias has been described in three patients for whom other tactics for abdominal wall repairs were not available.