Clarke John M
1609 Pasadena Ave., Saint Petersburg, FL 33707, USA.
Am J Surg. 2010 Jul;200(1):2-8. doi: 10.1016/j.amjsurg.2009.07.029.
Most ventral incisional hernias are repaired using 1 of 2 principal techniques: (1) prosthetic repair (open or laparoscopic) and (2) primary reconstruction by fascial component separation. Primary midline restoration provides physiological advantages, and avoidance of mesh may reduce complications. This report describes 128 cases of incisional hernia repair by fascial release. Evolution of the technique produced modifications and fewer complications.
Fascial component separation was performed either by "classic" technique (broad skin flaps) in group 1 and by "perforator preservation" (fascial release through separate inferolateral incisions) in group 2.
Mortality was .75% (1/128). Major complications occurred in 7 patients (5.5%). Total recurrence rate is 16% (21/128) with major recurrences in 9.3% (12/128). Both groups were statistically equivalent in demographics, comorbidities, and recurrences. Group 1 had significantly higher rates of skin necrosis (P < .001) and chronic pain (P = .003).
Fascial component separation can provide satisfactory results in uncomplicated incisional hernias, but skin necrosis is prohibitive without perforator preservation.
大多数腹直肌切口疝的修复采用两种主要技术之一：（1）假体修复（开放或腹腔镜）和（2）通过筋膜成分分离进行一期重建。一期中线修复具有生理优势，避免使用补片可能会减少并发症。本报告描述了128例通过筋膜松解进行切口疝修复的病例。该技术的发展产生了改进并减少了并发症。
在第1组中通过“经典”技术（宽皮瓣）进行筋膜成分分离，在第2组中通过“穿支保留”（通过单独的下外侧切口进行筋膜松解）进行。
死亡率为0.75%（1/128）。7例患者（5.5%）发生了主要并发症。总复发率为16%（21/128），主要复发率为9.3%（12/128）。两组在人口统计学、合并症和复发方面在统计学上相当。第1组皮肤坏死率（P < 0.001）和慢性疼痛率（P = 0.003）明显更高。
筋膜成分分离可在无并发症的切口疝中提供满意的结果，但在没有穿支保留的情况下皮肤坏死发生率过高。
