It won't close — now what?

✍ Scribed by Bernard Gardner

• Publisher: John Wiley and Sons
• Year: 1992
• Tongue: English
• Weight: 65 KB
• Volume: 50
• Category: Article
• ISSN: 0022-4790
• DOI: 10.1002/jso.2930500206

✦ Synopsis

THIS IS HOW I DO IT

It Won't Close -Now What?

Resections of tumors of the chest or abdominal wall frequently leave large defects that may require movement of tissue (i.e., free transfers) to close. This may also occur when large intra-abdominal tumors are fixed to the abdominal wall and en bloc resection may leave a wound impossible to close permanently.

On these occasions we have used ox fascia which has been sterilized using ethylene oxide and is available as Ocefasiaa from Roux-Ocefu, Buenos Aires, Argentina (supplied by Cochrane Hospital Supplies, New Rochelle, NY) to simplify closure of the chest or abdomen.

This material comes in sterile plastic containers in 10 X 20 cm sheets and is not rejected by the body. After removal of the plastic wrapper the sheet is soaked in several changes of saline for 20 min, during which time it softens and becomes very pliable. Where a large fascia1 defect is present the ox fascia is sewn to the patient's fascia with any non-absorbable suture so that there is no tension. An appropriate skin and subcutaneous closure is all that is required either primarily or by rotating a flap. It is not possible to skin graft directly onto this material.

The advantages are:

1. It can be placed directly onto lung or an abdominal