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Hernia
Published in: Hernia 1/2007

01-02-2007 | Case Report

The omentum–polypropylene sandwich technique: an attractive method to repair large abdominal-wall defects in the presence of contamination or infection

Authors: R. P. Bleichrodt, A. W. Malyar, T. S. de Vries Reilingh, O. Buyne, J. J. Bonenkamp, H. van Goor

Published in: Hernia | Issue 1/2007

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Abstract

Background

Repair of abdominal wall defects in the presence of contamination or infection continues to be a significant problem for surgeons. The loss of tissue warrants reinforcement of the abdominal wall, preferably by autologous material. However, autologous repair often requires extensive operations that carry a high morbidity. Moreover, the lack of sufficient fascia may be so extensive that insertion of a prosthetic material is inevitable. Polypropylene (PP) is the most appropriate material to use under these circumstances, but without coverage, the mesh will wrinkle and ultimately be extruded. The present report describes an alternative technique for repair of heavily contaminated abdominal-wall defects.

Patients

Two patients with a very large heavily contaminated abdominal wall defect due to necrotizing fasciitis in one patient and a lion’s bite in the other were treated with the omental sandwich technique. After radical debridement, resulting in a full thickness loss of the abdominal wall, the peritoneum was restored using absorbable polyglactin mesh. The fascial defect was bridged with a PP mesh that was fixed to the adjacent myoaponeurosis and covered with a pedicled omental flap. In both patients the omentum was covered with a split skin.

Results

Wound healing in both patients was without complications. Both patients had a sufficient abdominal wall, without signs of herniation after a follow up of 4 and 30 months, respectively.

Conclusion

The omental sandwich technique is an attractive method to repair large abdominal wall defects in the presence of contamination or overt infection.
Literature
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de Vries Reilingh TS, van Goor H, Rosman C, Bemelmans MH, de Jong D, van Nieuwenhoven EJ, van Engeland MI, Bleichrodt RP (2003) “Components separation technique” for the repair of large abdominal wall hernias. J Am Coll Surg 196(1):32–37PubMedCrossRef
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Metadata
Title
The omentum–polypropylene sandwich technique: an attractive method to repair large abdominal-wall defects in the presence of contamination or infection
Authors
R. P. Bleichrodt
A. W. Malyar
T. S. de Vries Reilingh
O. Buyne
J. J. Bonenkamp
H. van Goor
Publication date
01-02-2007
Publisher
Springer-Verlag
Published in
Hernia / Issue 1/2007
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-006-0174-3

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