Vertrees Amy, Kellicut Dwight, Ottman Shane, Peoples George, Shriver Craig
Department of General Surgery, Walter Reed Army Medical Center, Washington, DC, USA.
J Am Coll Surg. 2006 May;202(5):762-72. doi: 10.1016/j.jamcollsurg.2006.02.008.
Twenty-nine of 1,284 battle-injured soldiers arriving at Walter Reed Army Medical Center from Operations Enduring Freedom and Iraqi Freedom have abdominal wounds requiring delayed definitive closure with Gore-Tex (WL Gore & Assoc) mesh.
Serial abdominal closure (SAC) leading to early definitive abdominal closure (EDAC) was achieved using Gore-Tex mesh. Inpatient records of Operations Enduring Freedom and Iraqi Freedom soldiers with open or reopened abdomens were reviewed from March 2003 to August 2005.
Twenty-nine soldiers, average age 27 years (range 20 to 42 years) injured by secondary blast effects (n = 19); penetrating (n = 8); motor vehicle crashes (n = 1); and crushing injury (n = 1) were included in the study. Patients arrived at Walter Reed Army Medical Center 8 days (range 3 to 56 days) after injury with Gore-Tex mesh placed 6 days (range 0 to 26 days) from arrival and 14 days (range 4 to 79 days) from injury. SAC was achieved with towel clamp tightening or excision of midline mesh and drawing fascia closer to the midline for an average of 46 days (range 15 to 160 days) before EDAC. One patient is undergoing SAC and another was transferred to another facility. EDAC was achieved in 24 of the remaining of 27 patients (89%). Four patients required early removal of the Gore-Tex mesh, resulting in three patients with planned ventral hernia. One patient underwent EDAC with primary closure and fascial release. EDAC was completed with polypropylene mesh in 17 patients and 6 patients had original Gore-Tex in place. Patients were discharged from the hospital an average of 18 days after closure (range 1 to 89 days) with total hospital days of 62 (range 17 to 197 days). Average followup of patients from placement of Gore-Tex mesh is 264 days (range 31 to 855 days).
SAC with Gore-Tex mesh led to EDAC in 89% of patients and proved to be a safe and effective alternative to planned ventral hernia. SAC allowed protection of abdominal contents, effective fluid management, reclamation of abdominal domain, and early rehabilitation with minimal complications and only one hernia reoccurrence.
从“持久自由行动”和“伊拉克自由行动”中抵达沃尔特里德陆军医疗中心的1284名战伤士兵中，有29人腹部受伤，需要使用戈尔公司生产的戈尔特斯（Gore-Tex）补片进行延迟确定性缝合。
使用戈尔特斯补片实现系列性腹部闭合（SAC），从而达到早期确定性腹部闭合（EDAC）。回顾了2003年3月至2005年8月期间“持久自由行动”和“伊拉克自由行动”中腹部开放或重新开放的士兵的住院记录。
本研究纳入了29名士兵，平均年龄27岁（范围为20至42岁），受伤原因包括二次爆炸伤（n = 19）、穿透伤（n = 8）、机动车碰撞伤（n = 1）和挤压伤（n = 1）。患者在受伤后8天（范围为3至56天）抵达沃尔特里德陆军医疗中心，戈尔特斯补片在抵达后6天（范围为0至26天）、受伤后14天（范围为4至79天）放置。在实现EDAC之前，通过毛巾夹收紧或切除中线补片并将筋膜拉向中线来实现SAC，平均持续46天（范围为15至160天）。1例患者正在进行SAC，另1例转至其他机构。其余27例患者中有24例（89%）实现了EDAC。4例患者需要早期取出戈尔特斯补片，导致3例患者计划发生腹侧疝。1例患者通过一期缝合和筋膜松解进行了EDAC。17例患者使用聚丙烯补片完成了EDAC，6例患者保留了原有的戈尔特斯补片。患者在闭合后平均18天（范围为1至89天）出院，总住院天数为62天（范围为17至197天）。从放置戈尔特斯补片起对患者的平均随访时间为264天（范围为31至855天）。
使用戈尔特斯补片进行SAC使89%的患者实现了EDAC，并且被证明是一种安全有效的替代计划腹侧疝的方法。SAC能够保护腹腔内容物、有效进行液体管理、恢复腹腔空间并实现早期康复，并发症最少，仅1例疝复发。
