Bellows Charles F, Albo Daniel, Berger David H, Awad Samir S
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Michael E. DeBakey Veterans Affairs Hospital, m/c 112, 2002 Holcombe Blvd., Houston, TX 77030, USA.
Am J Surg. 2007 Aug;194(2):192-8. doi: 10.1016/j.amjsurg.2006.11.012.
The surgical repair of abdominal wall defects that cannot be closed primarily in contaminated fields is a difficult problem. The use of nonabsorbable synthetic materials usually is contraindicated in this setting because of the risk for colonization and chronic infection of the mesh. In this study we sought to determine the safety and efficacy of implanted human acellular dermal graft for abdominal wall reconstruction.
The records of all patients (n = 20) who underwent a repair of an abdominal wall defect with human acellular dermal graft at a Veteran Affairs hospital were reviewed retrospectively. Patient demographics, complications, and hernia recurrence were recorded.
There were 15 perioperative complications in 11 patients: 6 graft dehiscences, 1 evisceration, 2 postoperative intra-abdominal bleeds, 5 bacterial graft infections, and 1 death. Patients with heart disease, American Society of Anesthesiologists classification of 4, and/or dirty wounds were more likely to have perioperative complications. The median follow-up period was 9.4 months (range, 2-16 mo), during which 6 hernia recurrences were noted.
Human acellular dermis use is safe in abdominal wall reconstructions in contaminated surgical wounds.
在污染区域无法直接缝合的腹壁缺损的手术修复是一个难题。由于补片存在定植和慢性感染的风险，通常不建议在这种情况下使用不可吸收的合成材料。在本研究中，我们试图确定植入人脱细胞真皮移植物用于腹壁重建的安全性和有效性。
回顾性分析一家退伍军人事务医院所有接受人脱细胞真皮移植物修复腹壁缺损的患者（n = 20）的记录。记录患者的人口统计学资料、并发症和疝复发情况。
11例患者出现15例围手术期并发症：6例移植物裂开，1例脏器脱出，2例术后腹腔内出血，5例细菌性移植物感染，1例死亡。患有心脏病、美国麻醉医师协会分级为4级和/或伤口污染的患者更易发生围手术期并发症。中位随访期为9.4个月（范围2 - 16个月），在此期间发现6例疝复发。
在污染手术伤口的腹壁重建中使用人脱细胞真皮是安全的。
