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October 1988

Severe Intra-abdominal Sepsis and Open Management

Arch Surg. 1988;123(10):1287. doi:10.1001/archsurg.1988.01400340113023

To the Editor.—We read with interest the article by Garcia-Sabrido et al1 in the February 1988 issue of the Archives on the "open-abdomen" management of severe intra-abdominal sepsis, and we agree, in principle, with their philosophy. We wish to refer to the "Discussion" section that follows their article.

Dr Egmund alludes to our "sandwich technique"2 but mistakenly mentions the use of a lap pad. In fact, the technique involves the placement of a polypropylene mesh (Marlex) to prevent evisceration through the abdominal defect; in addition, a large incise drape (op-site) covers the defect and a wide margin of surrounding skin, and suction-irrigation tubes are interposed between the Marlex mesh and the opsite.

The use of a Marlex mesh has considerably simplified the management of the open abdomen3 by preventing evisceration and decreasing the incidence of "spontaneous" bowel fistulas all too often seen when gauze packs are