Original communication| Volume 69, ISSUE 1, P111-116, January 1971

Cause and repair of large incisional hernias

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      The author calculated the pressure of sutures on the aponeurosis in cases of large incisional hernia. The pressures were found to be very much higher than the highest that occur physiologically. It is thought that this is the explanation of the high frequency of recurrence after repair of incisional hernia. When this pressure is evenly distributed over a much larger surface of aponeurotic tissue and applied at a location about 2.5 cm. from the edges of the aponeurotic defect, the latter will have a relatively intact circulation. Consequently, with the use of a closure device developed by Ton,9 healing can proceed undisturbedly. Furthermore, this method implies the eventual removal of all nonabsorbable material after three to six weeks. Experience in 58 patients with incisional hernia is described; only five recurrences are reported.
      Also there appear to be both “soft” and “hard” types of aponeurosis in different patients. Soft aponeurosis splits easily with moderate pull; this characteristic may explain why some patients develop a hernia after a primary repair in the abdominal wall whereas others do not.
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