Prosthetic Material

The use of prosthetic material in open ventral and incisional hernia repair continues to be studied as well (Luijendijk et al, 2000). The initial report of the use of mesh in the reconstruction of large abdominal wall defects appeared in the surgical literature in 1903 and described the use of silver wire mesh (Bartlett, 1903). Use of this material was abandoned because of a significant degree of erosion into other structures. The use of modern material began in 1959 with the introduction of polypropylene (Marlex) mesh (Usher,

1959). This material along with polytetrafluoroethylene (Goretex or Teflon) or a composite material of the two represents the majority of prosthetic materials used today. The classic use of these materials is either as an inset patch or as reinforcement of a primary tissue repair of myofascia. Placement of these materials can be done extrafascial or above the fascia, extraperitoneal and subfascial, or intraperitoneal. This too continues to be a much-debated topic. Complications of the use of mesh include separation of the mesh from the fascia, contact injury (eg, adherence to other structures, erosion, and fistula formation), and infection. Autogenous tissue is considered by some to be the ideal material to close complex myofascial defects. The source of the tissue can be regional musculofascial flaps most commonly represented by rectus abdominis advancement, which can be achieved using one of several plastic surgery tissue advancement techniques, or the use of distant flaps, including the tensor fascia lata or rectus femoris of the thigh or latissimus dorsi.

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