Holton Luther H, Kim Daniel, Silverman Ronald P, Rodriguez Eduardo D, Singh Navin, Goldberg Nelson H
University of Maryland and Johns Hopkins Schools of Medicine, Baltimore, Maryland 21201, USA.
J Long Term Eff Med Implants. 2005;15(5):547-58. doi: 10.1615/jlongtermeffmedimplants.v15.i5.70.
The use of prosthetic mesh for the tension-free repair of incisional hernias has been shown to be more effective than primary suture repair. Unfortunately, prosthetic materials can be a suboptimal choice in a variety of clinical scenarios. In general, prosthetic materials should not be implanted into sites with known contamination or infection because they lack an endogenous vascular network and are thus incapable of clearing bacteria. This is of particular relevance to the repair of recurrent hernias, which are often refractory to repair because of indolent bacterial colonization that weakens the site and retards appropriate healing. Although fascia lata grafts and muscle flaps can be employed for tension-free hernia repairs, they carry the potential for significant donor site morbidity. Recently, a growing number of clinicians have used human acellular dermal matrix as a graft material for the tension-free repair of ventral hernias. This material has been shown to become revascularized in both animal and human subjects. Once repopulated with a vascular network, this graft material is theoretically capable of clearing bacteria, a property not found in prosthetic graft materials. Unlike autologous materials such as fascial grafts and muscle flaps, acellular dermal matrix can be used without subjecting the patient to additional morbidity in the form of donor site complications. This article presents a thorough review of the current literature, describing the properties of human acellular dermal matrix and discussing both animal and human studies of its clinical performance. In addition to the review of previously published clinical experiences, we discuss our own preliminary results with the use of acellular dermal matrix for ventral hernia repair in 46 patients.
人工合成补片用于切口疝的无张力修补已被证明比一期缝合修补更有效。不幸的是，在多种临床情况下，人工合成材料可能并非最佳选择。一般来说，人工合成材料不应植入已知有污染或感染的部位，因为它们缺乏内源性血管网络，因此无法清除细菌。这对于复发性疝的修补尤为重要，由于慢性细菌定植削弱了修补部位并阻碍了正常愈合，复发性疝的修补往往很困难。虽然阔筋膜移植和肌瓣可用于无张力疝修补，但它们存在供区发生严重并发症的风险。最近，越来越多的临床医生使用人脱细胞真皮基质作为腹疝无张力修补的移植材料。这种材料在动物和人体中均已显示可实现血管化。一旦重新形成血管网络，这种移植材料理论上能够清除细菌，这是人工合成移植材料所不具备的特性。与阔筋膜移植和肌瓣等自体材料不同，脱细胞真皮基质的使用不会给患者带来供区并发症等额外的发病风险。本文对当前文献进行了全面综述，描述了人脱细胞真皮基质的特性，并讨论了其临床性能的动物和人体研究。除了回顾先前发表的临床经验外，我们还讨论了我们自己使用脱细胞真皮基质对46例患者进行腹疝修补的初步结果。
