An Gary, Walter Robert J, Nagy Kimberly
Department of Trauma, Stroger Cook County Hospital, Chicago, Illinois, USA.
J Trauma. 2004 Jun;56(6):1266-75. doi: 10.1097/01.ta.0000068241.66186.00.
After some abdominal surgical procedures, the abdominal wall defect may be too large for closure by tension-free approximation of the wound margins because of tissue loss or swelling of the abdominal viscera. A variety of absorbable and nonabsorbable prosthetic materials have been used for emergency abdominal wall reconstruction. Of these materials, polytetrafluoroethylene (PTFE) sheets have proved to be the most efficacious.
This study compared the efficacy of allogenic acellular dermal matrix (ADM) and PTFE as prosthetic materials for wound closure in rats with surgical, full-thickness, 2 x 3-cm abdominal wounds. Healing was studied among animals with and those without experimentally induced peritonitis for 21 days after surgery.
Acellular dermal matrix became vascularized and incorporated into the wound bed and was partially or fully epithelialized without the need for skin grafting. As a result, little superficial bleeding was seen, and ADM effectively closed the wounds even in the presence of peritonitis. Wounds treated with ADM also showed a significant reduction in wound area (sterile:p < 0.001; contaminated:p < 0.05). In contrast, PTFE temporarily closed the wounds, but was not incorporated into them. It consequently evoked the formation of extensive underlying granulation tissue that showed significant superficial bleeding when the PTFE was removed. Very limited wound contraction occurred in PTFE-treated wounds, and some instances of evisceration and fistula formation were observed. Wounds treated with both types of material showed significant amounts of adhesion to visceral organs underlying the wound site.
Acellular dermal matrix exhibits a number of favorable features relative to PTFE for closing sterile or contaminated full-thickness abdominal wall defects.
一些腹部手术后，由于组织缺失或腹腔脏器肿胀，腹壁缺损可能过大，无法通过无张力拉拢伤口边缘来闭合。多种可吸收和不可吸收的假体材料已被用于紧急腹壁重建。在这些材料中，聚四氟乙烯（PTFE）片已被证明是最有效的。
本研究比较了同种异体脱细胞真皮基质（ADM）和PTFE作为假体材料在大鼠2×3厘米全层手术性腹部伤口闭合中的效果。在术后21天对有或无实验性腹膜炎的动物的愈合情况进行研究。
脱细胞真皮基质血管化并融入伤口床，无需植皮即可部分或完全上皮化。因此，几乎看不到浅表出血，即使在存在腹膜炎的情况下，ADM也能有效闭合伤口。用ADM治疗的伤口在面积上也有显著减少（无菌：p<0.001；污染：p<0.05）。相比之下，PTFE暂时闭合了伤口，但未融入其中。因此，它引发了广泛的深层肉芽组织形成，当去除PTFE时，深层肉芽组织出现明显的浅表出血。PTFE治疗的伤口收缩非常有限，并且观察到一些内脏脱出和瘘管形成的情况。两种材料治疗的伤口均显示出与伤口部位下方内脏器官的大量粘连。
相对于PTFE，脱细胞真皮基质在闭合无菌或污染的全层腹壁缺损方面具有许多有利特征。
