Parker David M, Armstrong Peter J, Frizzi James D, North James H
Eisenhower Army Medical Center, Fort Gordon, Georgia, USA.
Curr Surg. 2006 Jul-Aug;63(4):255-8. doi: 10.1016/j.cursur.2006.05.003.
A review of Eisenhower Army Medical Center's experience using Permacol (Tissue Science Laboratories, Covington, Georgia) for the repair of abdominal wall defects.
Retrospective review of medical records of patients undergoing abdominal wall reconstruction with Permacol.
From July 30, 2003 to February 12, 2005, 9 patients underwent repair of complicated fascial defects with Permacol. Indications for surgery included reoperative incisional hernia repair after removal of a infected mesh (3 patients), reconstruction of a fascial defect after resection of an abdominal wall tumor (2 patients), incisional hernia repair in a patient with a previous abdominal wall infection after a primary incisional hernia repair (1 patient), incisional hernia repair in a patient with an ostomy and an open midline wound (1 patient), emergent repair of incisional hernia with strangulated bowel and multiple intra-abdominal abscesses (1 patient), and excision of infected mesh and drainage of intra-abdominal abscess with synchronous repair of the abdominal wall defect (1 patient). At a median follow-up of 18.2 months, 1 recurrent hernia existed after intentional removal of the Permacol. This patient developed an abdominal wall abscess 7 months after hernia repair secondary to erosion from a suture. Overall, 1 patient developed exposure of the Permacol after a skin dehiscence. The wound was treated with local wound care, and the Permacol was salvaged. Despite the presence of contamination (wound classification II, III, or IV) in 5 of 9 patients (56%), no infectious complications occurred.
Complex reconstruction of the abdominal wall can be associated with a high complication rate. Placement of a permanent prosthetic mesh in a contaminated field is associated with a high rate of wound infections and subsequent mesh removal. Permacol becomes incorporated by tissue ingrowth and neovascularization. Permacol is a safe and acceptable alternative to prosthetic mesh in the repair of complicated abdominal wall defects.
回顾艾森豪威尔陆军医疗中心使用Permacol（组织科学实验室，佐治亚州卡温顿）修复腹壁缺损的经验。
对接受Permacol腹壁重建的患者病历进行回顾性分析。
2003年7月30日至2005年2月12日，9例患者使用Permacol修复复杂的筋膜缺损。手术适应证包括移除感染补片后再次进行切口疝修补（3例）、腹壁肿瘤切除后筋膜缺损重建（2例）、初次切口疝修补术后腹壁感染患者的切口疝修补（1例）、造口患者合并开放性中线伤口的切口疝修补（1例）、绞窄性肠管伴多发腹腔内脓肿的切口疝急诊修补（1例）以及切除感染补片并引流腹腔内脓肿同时修复腹壁缺损（1例）。中位随访18.2个月时，1例患者在有意移除Permacol后出现复发性疝。该患者在疝修补术后7个月因缝线侵蚀继发腹壁脓肿。总体而言，1例患者在皮肤裂开后出现Permacol外露。伤口经局部伤口护理处理，Permacol得以保留。尽管9例患者中有5例（56%）存在污染（伤口分类为Ⅱ、Ⅲ或Ⅳ类），但未发生感染并发症。
腹壁的复杂重建可能伴有较高的并发症发生率。在污染区域放置永久性人工补片会导致较高的伤口感染率及随后的补片移除率。Permacol可通过组织长入和新生血管形成而整合。在修复复杂腹壁缺损时，Permacol是人工补片的一种安全且可接受的替代物。
