PROPHYLACTIC MESH REINFORCEMENT IN THE CLOSURE OF EMERGENCY MIDLINE LAPAROTOMIES IN CONTAMINATED AND INFECTED FIELDS: A CRITICAL REVIEW OF EFFICACY, SAFETY, AND CLINICAL APPLICABILITY

Abstract

Prophylactic mesh reinforcement during emergency midline laparotomy closure aims to prevent fascial dehiscence and incisional hernia, but its use in contaminated fields remains controversial. This critical narrative review examined efficacy, safety, and applicability to Centers for Disease Control and Prevention wound classes III and IV. The project bibliography was reassessed and supplemented with targeted verification of primary studies and guidelines through October 26, 2026. Study design, baseline characteristics, mesh material and placement, and outcome-specific denominators and follow-up were retained. Six comparative studies formed the descriptive core. The Lima trial reported fascial dehiscence in 0/63 mesh recipients and 7/52 controls, with more surgical-site infections and seromas in the mesh group. The Kurmann and Bravo-Salva observational studies reported fewer incisional hernias, although confounding and selection limited causal interpretation. PREEMER had few events and substantial attrition. Evidence involving intraperitoneal biological mesh and intestinal perforation raised specific safety concerns. Materials and implantation planes cannot be assumed equivalent, and findings from mixed populations should not be generalized to all contaminated or dirty wounds. Prophylactic reinforcement may benefit selected patients, but clinical decisions require individualized assessment of fascial failure, prosthetic complications, and the limitations of available evidence.