Management of massive abdominal wall defects: role of porcine skin grafts.

Primary closure with "minimal tension" of an inadequately debrided massive abdominal wall defect invariably results in further necrosis and dehiscence. Rotation flaps and prosthetic materials are potentially hazardous in severely traumatized and contaminated wounds. An alternate technique, utilizing an abdominal wall pack and porcine skin graft has been used in two patients with close-range shotgun blasts and one patient with postoperative necrotizing fascitis. The combination of a biological dressing and an abdominal wall pack, stinted by strategically placed retention sutures, controls infection, promotes healthy granulation tissue, and prevents bowel erosion with fistula formation.