E. Yeung1, M. Kaster1, D. Scheese1, T. Mathews1, G. Prezkop1, L. Lockhard1, C. Wung1, G. Ologun1, A. Trecartin1, D. Golden1, J. Granet1, R. Behm1 1Guthrie Clinic,Trauma & Surgical Critical Care,Sayre, PA, USA
Introduction: The use of synthetic mesh is considered too high risk and therefore not an option when closing a contaminated abdominal fascial defect. This study evaluated the clinical outcomes when using synthetic mesh combined with vacuum-assisted closure (VAC) dressing to close these facial defects.
Methods: From 2010 to 2016, a retrospective review was performed including 34 patients in a single rural trauma center who underwent a damage control laparotomy in the presence of a contaminated or infected field. Definitive abdominal closure with a bridging polypropylene mesh along with the application of a VAC dressing was done in all cases. Data collected included baseline demographics, operative indication, postoperative complications, mortality and length of follow up.
Results: Median age of the patients was 67 years (IQR 40-87 years) with 22 (65%) being male at the time of operation. Median duration of clinical follow-up for these 34 patients was 15.15 months. The observed complications included 0 mesh related fistulas, 2 hernias, 9 draining sinus tracts, and 3 mesh explanations with an overall complication rate of 41.1%. After excluding fistulas and hernias, the adjusted complication rate was found to be 35.3%. Absolute observed fistula rate was 8.8% with 3 cases of fistula formations; however, the adjusted mesh-related fistulas formation rate was 0.0%. No mortalities were attributed directly to mesh related complication. The evolution of one patient's wound can be seen in Figure 1.
Conclusion: This study found no mesh-related fistula formation when using a synthetic mesh along with a VAC dressing for abdominal closure in a contaminated field. These results may provide a platform for further study regarding the safety of this technique.
