Reconstructing the abdominal wall with a biocompatible patch.

A 54-year-old man had considerable visceral swelling after laparotomy for intraabdominal infection, and primary closure could not be achieved. We provided temporary abdominal closure with a presterilized 3-L cystoscopy fluid bag (Fig. 1). The following day we inserted a Wittmann Patch using a cellophane sheet to prevent adhesions between the intestine and the abdominal wall and wound. We sutured 2 sheets of material to opposing fascial edges that bordered the abdominal opening. The softer loop sheet was sutured to the right fascia by a running, looped 1-0 nylon suture with the harder hook sheet similarly sutured to the left fascia. We gently pressed the hooks into the loops of the loop sheet, thus providing safe closure (Fig. 2). On top of the patch sheets we placed gauze material around a large bore suction drain establishing a wound dressing; the skin edges were opposed loosely with 2-0 Prolene suture to prevent skin retraction. We covered the entire wound with an occlusive self-adhesive plastic drape. As the abdominal swelling subsided, we gradually reapproximated the fascial edges by drawing the 2 sheets closer together, cutting away excess material and following the dressing regimen described previously. When the 2 fascial edges were sufficiently close (day 12), we removed the remaining patch material and closed the abdominal wall, fascia-to-fascia, and skin. Discussion