Chavarriaga Luis Felipe, Lin Edward, Losken Albert, Cook Michael W, Jeansonne Louis O, White Brent C, Sweeney John F, Galloway John R, Davis S Scott
Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Am Surg. 2010 Jan;76(1):96-100.
Multiple techniques have been used for the repair of complex abdominal wall defects after recurrent incisional hernias with varying rates of success. Primary repair has been associated with high recurrence rates, and prosthetic mesh placement is contraindicated in contaminated surgical fields. The development of biologic prostheses has changed the approach to these difficult problems. This study evaluates the management of complex abdominal wall defects using acellular porcine dermal collagen. Between August 2006 and May 2007, 18 patients underwent abdominal wall reconstruction for complex defects with acellular porcine dermal collagen (CollaMend; Bard Inc., Warwick, RI). Patient demographics, preoperative risk factors, previous herniorrhaphy attempts, postoperative complications, recurrences, and long-term results were retrospectively reviewed. Records were reviewed at a mean follow up of 7.3 months; the recurrence rate was 44.4 per cent. A total of 38.9 per cent (seven of 18) developed a postoperative wound complications, including infection in 22.2 per cent (four of 18). All of the patients with infection required prosthesis removal as a result of encapsulation rather than incorporation of the biologic prosthesis. Acellular porcine dermal collagen has the potential for reconstruction of abdominal wall defects with postoperative wound occurrences comparable with other biologic materials. Encapsulation of the material was a major problem in cases with wound infection that required graft removal rather than local wound measures. Hernia recurrence and dehiscence of the graft were problems in noncompromised surgical fields.
多种技术已被用于复发性切口疝后复杂腹壁缺损的修复，成功率各不相同。一期修复与高复发率相关，并且在污染的手术区域禁忌放置人工合成补片。生物补片的发展改变了处理这些难题的方法。本研究评估了使用脱细胞猪真皮胶原蛋白处理复杂腹壁缺损的情况。在2006年8月至2007年5月期间，18例患者使用脱细胞猪真皮胶原蛋白（CollaMend；巴德公司，罗德岛州沃里克）进行了复杂腹壁缺损的重建。对患者的人口统计学资料、术前危险因素、既往疝修补术尝试情况、术后并发症、复发情况及长期结果进行了回顾性分析。在平均随访7.3个月时查看记录；复发率为44.4%。共有38.9%（18例中的7例）发生了术后伤口并发症，其中22.2%（18例中的4例）发生感染。所有感染患者均因生物补片被包裹而非融合而需要取出补片。脱细胞猪真皮胶原蛋白具有用于重建腹壁缺损的潜力，术后伤口情况与其他生物材料相当。在伤口感染需要取出补片而非采取局部伤口处理措施的病例中，材料被包裹是一个主要问题。在未出现并发症的手术区域，疝复发和补片裂开是问题所在。
