We appreciate the comments by Losanoff et al1 regarding our article on the utility of absorbable mesh for temporary abdominal coverage in the severely injured2; however, they misquoted Table 3 by substituting raw numbers for percentages and adding the 2 columns. Our bowel fistula rate was actually 11 (15%) of 73 patients, and not 34 (47%) of 73 patients as they implied. We agree, however, that mesh placed directly on the bowel increases the risk of fistula. Several techniques have evolved that have decreased our current bowel fistula rate to 1 (4%) in the last 24 patients. We first attempt to insert the omentum between the mesh and the viscera and place petroleum jelly-impregnated gauze over the mesh. Moist gauze, suction drains, a towel, and antimicrobial incise drape (Ioban, 3M, St Paul, Minn) are placed over the wound to keep it sealed, followed up with postoperative bladder pressures to detect intra-abdominal hypertension. We do not change the dressing until the next operation. If we cannot close the fascia in the first several days, we rapidly move to skin and subcutaneous tissue flap coverage. Skin grafts are used to cover any persistent exposed viscera. Using a similar strategy, Ivatury et al3 reported a bowel fistula rate of 1% to 2%.
Mayberry JC, Mullins RJ, Crass RA, Trunkey DD. Postoperative Complications of Temporary Abdominal Surgery. Arch Surg. 1998;133(12):1370–1371. doi:
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