A Narrative Review of Mesh Suture in Abdominal Wall Reconstruction: Biomechanics, Early Outcomes, and Proposed Clinical Algorithm.

Background: Suture repair of abdominal wall defects is prone to failure due to suture pull-through. In contrast, planar mesh reinforcement improves durability but is limited by increased foreign body burden, need for additional tissue dissection, and challenges in contaminated fields. Mesh suture offers a potential alternative combining both the ease of suture repair with improved load distribution and early tissue integration, characteristics of planar mesh repairs. This review summarizes the biomechanical rationale, histologic characteristics, and early clinical experiences with mesh suture to date. Methods: A narrative review of preclinical and clinical literature regarding mesh suture was performed using a targeted search of PubMed and Google Scholar with key terms ("mesh suture" or "Duramesh"). Studies were included if they evaluated mesh suture in biomechanical, preclinical or clinical contexts. A proposed clinical algorithm based on institutional experiences is presented to illustrate patient selection and technique. Results: Preclinical studies demonstrate favorable mechanical performance and early fibrovascular incorporation. Early clinical data from registries and institutional cohorts suggests mesh suture is feasible even in contaminated settings with outcomes that compare to both standard suture and planar mesh repairs. Conclusion: Mesh suture may offer a reinforcement strategy that balances mechanical support with tissue preservation in abdominal wall reconstruction. Current clinical evidence remains preliminary, and additional prospective, randomized studies are needed to more definitely evaluate its clinical performance over time.