Absorbable mesh and topical negative pressure therapy for closure of abdominal dehiscence with exposed bowel.

Permacol mesh is a porcine dermis-derived biomaterial used for the repair of abdominal incisional and inguinal hernia. It has been found to be a safe and effective alternative to non-absorbable mesh for application over exposed bowel. This mesh has also been successfully applied over contaminated abdominal wound beds and around stomas. Topical negative pressure therapy has been used for the management of wound complications after surgical implantation of Permacol mesh. We describe our experience with the combined use of Permacol mesh and simultaneous application of topical negative pressure therapy to aid wound contraction and granulation in a patient with abdominal dehiscence and exposed bowel.

The bacteriology of children before primary cleft lip and palate surgery.

OBJECTIVE: Bacterial infections can complicate any surgery. Knowledge of potentially pathogenic bacterial flora in children with cleft lip and palate allows appropriate risk management, including the need for prophylactic antibiotics. This project reviewed the bacteriology of children before primary cleft lip and palate surgery. DESIGN: A retrospective study of the results of nose, throat, and ear microbiological swabs taken from children, aged 1 to 26 months, before repair of primary cleft lip, cleft palate, or both was carried out. Swabs with Staphylococcus aureus and beta-hemolytic streptococcus were considered positive. RESULTS: From October 1987 to May 2002, 321 primary cleft lip or palate operations were performed in 250 patients. Results from 326 sets of preoperative swabs were available, including five repeat sets from patients whose operations were postponed. There were 235 (72.1%) negative sets and 91 (27.9%) positive sets. Of the positive swabs, 86 sets grew S. aureus, and 10 sets grew beta-hemolytic streptococcus. CONCLUSIONS: Children with unrepaired cleft lip and palate have a significant risk of carrying S. aureus and a small risk of carrying beta-hemolytic streptococci. These risks need to be considered when deciding on protocols for preoperative bacteriology tests and prophylactic antibiotics.