Ross Charles B, Irwin Chance L, Mukherjee Kaushik, Schumacher Paul M, Dattilo Jeffery B, Ranval Timothy J, Guzman Raul J, Naslund Thomas C
Division of Vascular Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Am Surg. 2009 Jul;75(7):565-70; discussion 570-1.
Patients who undergo open repair of ruptured abdominal aortic aneurysms (rAAA) may require delayed abdominal wound closure to prevent the adverse consequences of intra-abdominal hypertension and abdominal compartment syndrome. However, surgeons may be reticent to use delayed abdominal closure techniques due to concern that such management may increase the risk of graft infection. We retrospectively reviewed our patient experience with rAAA and other vascular catastrophes in which vacuum-pack abdominal wound management with delayed closure was used between 2000 and 2007. Eighteen of 23 patients treated with delayed closure survived (78%). In five early deaths, graft infection was not clinically suspected. Sixteen of 20 rAAA patients survived, with abdominal wound closure achieved at a mean of 4 days. Mean follow up was 53 months, the longest among comparable series. Graft infection has not been encountered in this group. Our results suggest that the potential risk of graft infection should not outweigh the benefits of vacuum-pack temporary abdominal wound management with delayed closure in critically ill patients at high risk for intra-abdominal hypertension and abdominal compartment syndrome after major abdominal vascular procedures.
接受破裂腹主动脉瘤（rAAA）开放修复术的患者可能需要延迟腹部伤口闭合，以预防腹内高压和腹腔间隔室综合征的不良后果。然而，由于担心这种处理方式可能增加移植物感染风险，外科医生可能不愿使用延迟腹部闭合技术。我们回顾性分析了2000年至2007年间采用负压包扎腹部伤口管理并延迟闭合的rAAA及其他血管急症患者的治疗经验。23例接受延迟闭合治疗的患者中有18例存活（78%）。在5例早期死亡病例中，临床上未怀疑移植物感染。20例rAAA患者中有16例存活，腹部伤口平均在4天闭合。平均随访53个月，在可比系列中随访时间最长。该组未发生移植物感染。我们的结果表明，对于接受大型腹部血管手术后发生腹内高压和腹腔间隔室综合征高危的重症患者，移植物感染的潜在风险不应超过负压包扎临时腹部伤口管理并延迟闭合的益处。
