During a literature view performed by patient safety operations on 8/6/2021, an article titled "the case for onlay biologic mesh in abdominal wall reconstruction using progressive tension suture fixation" was identified that discussed that a retrospective chart review of patients who underwent abdominal wall reconstruction from 2012 to 2019 at the university of alabama at birmingham.All surgeries were performed by the senior author.After exclusions, there were 59 female patients included in the study.The article explained that underlay and sublay placement of mesh slowly emerged as the standard of care in abdominal wall reconstruction because of lower hernia recurrence rates.However, onlay has the advantages of being faster, less invasive, and technically easier compared with underlay and sublay.Therefore, if a similar recurrence could be achieved, then onlay should be a consideration.In the study, they present a new onlay method using multipoint progressive tension suture fixation.The surgical technique described that the biologic mesh is attached to cover the anterior rectus sheath extending out to the lateral border of the rectus sheath.The progressive tension is achieved by placing the suture through the mesh and then angling out the suture laterally toward the anterior rectus fascia, as demonstrated in figure 1.This technique is called multipoint progressive tension suture fixation.The wound is irrigated and checked for hemostasis.Subcutaneous drains are routinely placed.The deep layer is closed with 0 vicryl, the deep dermal layer with 2-0 vicryl, and the skin with 3-0 monocryl.A negative pressure dressing is applied at the discretion of the senior author.Abdominal binders are used routinely, and antibiotics are prescribed until removal of subcutaneous drains.Average follow-up was 1134.79 ± 668.70 days (3.11 ±1.83 years) with a minimum of at least 1 year of follow-up.The rate of minor wound separation/necrosis was 45.8%, that of fluid collection such as hematoma/seroma was 20.3%, and that of wound infection/purulence was 20.3%.The hernia recurrence rate was 5.1%.Patient demographics, and medical and surgical histories consist of smoking, htn, diabetes, cardiovascular disease, lung disease and previous hernia repairs/abdominal wall operations.Other surgery details such as types of biologic mesh used and the rate of concomitant bowel resection are in table 2.Other secondary outcomes such as length of stay and reoperations for any reason (including superficial wound debridement) are in table 3.The study reports a 5.1% hernia recurrence rate in a high-risk population with complex defects at an average follow-up of 3.1 years using multipoint progressive tension suture fixation of biologic mesh in an onlay position.This recurrence rate is an improvement compared with previous biologic onlay meta analyses.The authors believe their progressive tension multipoint suture fixation technique is one of the major reasons for the improvement in the hernia recurrence rate compared with previous onlay studies.All of these advantages of onlay may translate into wider reproducibility, lower costs, and improved patient safety.This record is associated with the strattice mentioned in the article.
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Ref initial reporter: corresponding author and institution.This literature review is being reported as an individual event type as serious injury due to the reported surgical intervention.The corresponding author contact information is no longer valid; therefore follow up cannot be performed.If further information is received through the post market surveillance review of device literature, this event will be returned for further investigation.The lots associated with these events remain unknown; therefore a review of the device history records could not be performed.No strattice devices were returned for evaluation.Based on the limited information, a relationship to the strattice was not determined.No further actions are required, a nonconformance was not confirmed.If additional information is received, a supplemental report will be submitted.
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