A management technique of the open abdominal wound is described. It consists of a 'sandwich' composed of a Marlex mesh and an Op-Site wound dressing with interposition of suction tubes. Such a technique prevents evisceration, protects the skin, decreases evaporation, allows accurate fluid replacement, facilitates nursing and adds to the patient's comfort.

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Correspondence Authors' reply SirWe have no doubt that SVA is a useful pre-operative investigation in patients with undiagnosed gastrointestinal bleeding. Pre-operative diagnosis is always an advantage over inaccurate 'time honoured' procedures at laparotomy. Like many District General Hospitals we have a 24h upper gastrointestinal service but not an early lower gastrointestinal endoscopy service. It is reported that visualization can be particularly difficult during the latter procedure when bleeding is acute.In the 11 out of 386 patients in 2 years in whom SVA was done, it is true that the 4 tumours could have been found at blind laparotomy. However, it is highly unlikely that the bleeding points would have been found in the others, in whom the external surface of the bowel looked normal. It is notoriously dificult to localize angiodysplasia and A-V malformations by naked eye. Pre-operative localization with SVA enabled limited resection of the bleeding site. Often these patients are not bleeding at operation and so distension of a segment does not occur leaving the impossible question of how much to resect blindly.

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