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TAC

rwolfer at aol.com rwolfer at aol.com
Thu Aug 28 20:47:26 BST 2008


we change every couple of days. If just a "dressing change" we can do at bedside in ICU and just drape everything out.  The last time "back" we try to close and if still tight or cannot close will sew in vycryl mesh and wound vac or do dressing changes on top of that. another thing my chairman taught me is to just place a lot of retentions close to each other and use "bridges that can be tighened or loosended by turning dial. Will use this in pts that we can get the fascia close but not completely closed. Every couple of days just tighten up a bit and the fasica comes together .  You just have to be careful that you do not catch a piece of bowel in the closure. You can lay a piece of vicryl mesh just under fascia and close with these over top to help prevent this Even if you get it really close a small ventral hernia to fix down the road is better than a giant one.  Have tired a couple of times and seems to work well
RW



-----Original Message-----
From: Ranjith Ellawala <ranjithellawala at yahoo.com>
To: Trauma &amp, Critical Care mailing list <trauma-list at trauma.org>
Sent: Thu, 28 Aug 2008 2:52 pm
Subject: Re: TAC



Thank you.
 When we use a temp closure just as you described, We change every 2 nd day or 
o. Otherwise infection will sets in. 1.
 1.Is that your experience as well?
 2. If you are using absorbable mesh, how soon you could apply after DC 
urgery?
 Ranjith
rwolfer at aol.com wrote:
 if no wound vac we use a sandwich of blue towe
ls and ioban and put a large NG 
etween the layers to "suck out' the fluid that is hooked to low continous wall 
uction. I t works very well
 would not use prolene mesh but if you want mesh would use vicryl as it is 
bsorbable. you just end up with large ventral hernia later.  you could wait 
ntil it all granulates and then skin graft the defect. In 6 or so months when 
he pt is we.. and you can "pick skin graft off underlying tissue" we would 
emove and repair ventral hernia.
W

-----Original Message-----
rom: Ranjith Ellawala 
o: Trauma & Critical Care mailing list 
ent: Wed, 20 Aug 2008 1:25 pm
ubject: TAC

I use ‘opsite sandwitch’ initially for DC. We don’t have vaccum assisted 
ainage device nor absorbable mesh. but we have Plastic IV bags.
. Could I use polypropalene mesh safely?
. When do you think the best to change over to mesh if abdomen appears 
 be too tight for closure?
. Could you use either type of mesh in the presence of wound infection?
. What can you use to cover the mesh temporally?
our comments please
anjith Ellawala
olombo 
ri lanka
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