Repair of massive XXXX with "quilted" mesh.

@entity1 @entity281 @entity547 @entity2483 @entity4037
INTRODUCTION: Prosthetic reinforcement is a critical component of @entity547 repair. For massive defects, mesh overlap is often limited by the dimensions of commercially available implants. In scenarios where larger mesh prosthetics are required for adequate reinforcement, it may be necessary to join several pieces of mesh together using non-absorbable suture. Here, we report our outcomes for abdominal wall reconstructions in which "quilted" mesh was utilized for fascial reinforcement. METHODS: @entity1 undergoing open incisional @entity2483 and transversus abdominis muscle release, with use of quilted synthetic mesh placed in the retromuscular position, were reviewed. Main outcome measures included @entity1 , @entity547 , and operative characteristics and post-operative outcomes, including surgical site occurrence (SSO), @entity281 ( @entity281 ), and recurrence. RESULTS: Thirty-two @entity1 (mean age 55.7      9.3, BMI 38.3      5.8  kg/m(2)) underwent open @entity4037 repair with "quilted" mesh placed in the retromuscular position. The mean defect area was 760.1      311.0 cm(2) with a mean width of 24.7      6.4  cm. Quilted meshes consisted of two-piece (69  %), three-piece (19  %) and four-piece (12  %) configurations. Wound morbidity consisted of eight (25  %) SSOs, including four (13  %) SSIs, all of which resolved without mesh excision. With mean follow-up of 9.0      13.6  months, there were two (6.3  %) lateral recurrences, both unassociated with mesh-to-mesh suture line failure. CONCLUSIONS: Massive @entity4037 that require giant mesh prosthetics, currently not commercially available, may be successfully repaired using multiple mesh pieces sewn together in a quilt-like fashion. Such retromuscular repairs are durable, without added morbidity due to the mesh-to-mesh suture line. However, additional operative time is required for quilting the mesh together, prompting strong calls for manufacturing of larger mesh prosthetics.
