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Related Experiment Videos

Laparotomy wound closure with absorbable polyglycolic acid mesh

M A Greene1, R J Mullins, M A Malangoni

  • 1Oregon Health Sciences University, Department of Surgery, Portland 97201-3098.

Surgery, Gynecology & Obstetrics
|March 1, 1993
PubMed
Summary

Absorbable polyglycolic acid knit mesh successfully bridged abdominal wall defects in critically ill patients, preventing evisceration. While effective for wound closure, hernia defects were common post-absorption, requiring later repair.

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Area of Science:

  • Surgical Innovation
  • Biomaterials Science
  • Gastrointestinal Surgery

Background:

  • Abdominal wall defects pose significant challenges in critically ill patients, increasing risks of evisceration and complications.
  • Traditional mesh materials may lead to long-term complications or require removal.
  • The need for secure, tension-free abdominal wound closure in complex cases is paramount.

Purpose of the Study:

  • To evaluate the efficacy and safety of polyglycolic acid (PGA) knit mesh in closing abdominal wall defects.
  • To assess the outcomes of using absorbable PGA mesh in critically ill patients with various abdominal wall issues.
  • To determine the short-term and long-term complications associated with PGA knit mesh use.

Main Methods:

  • A prospective study involving 59 critically ill patients with abdominal wall defects.

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  • Application of polyglycolic acid knit mesh to bridge defects resulting from necrotizing fasciitis, trauma, tumor resection, or severe visceral edema.
  • Monitoring for wound healing, mesh integration, complications, and long-term outcomes including hernia formation.

    • Main Results:

    • PGA knit mesh was successfully used in 59 patients, demonstrating strength, pliability, and ease of insertion.
    • The mesh integrated with granulation tissue within three weeks, even in contaminated wounds, and was absorbed within 2-3 months.
    • Enterocutaneous fistulas occurred in 13 patients (7 post-mesh insertion); 14 hospital deaths occurred among the seriously ill cohort.
    • Hernia defects were common 4-6 months post-insertion, necessitating elective repair.

    Conclusions:

    • Absorbable polyglycolic acid knit mesh provides a useful technique for rapid, secure, tension-free abdominal wound closure.
    • The material's absorbability and integration support initial wound healing but may lead to late hernia formation.
    • PGA mesh is a viable option for managing abdominal wall defects in complex surgical scenarios, with elective hernia repair as a subsequent step.