Department of Surgery, Nishi Sapporo National Hospital, 7-1-1 Yamanote 5-jyo, Nishi-ku, Sapporo, 063-0005, Japan.
Surg Today. 2011 Sep;41(9):1252-4. doi: 10.1007/s00595-010-4436-4. Epub 2011 Aug 26.
Abdominal wound dehiscence is a serious complication of laparotomy, and fascial dehiscence in a patient with a stoma is especially difficult to manage. We describe how we performed local skin flap reconstruction for abdominal wound dehiscence in two patients with stomas. One patient underwent sigmoidectomy with a colostomy for peritonitis caused by perforated diverticulitis of the sigmoid colon. Postoperative fascial dehiscence was repaired by rhomboid flap reconstruction. The other patient underwent total gastrectomy, cholecystectomy, and splenectomy. An ileostomy was performed for digestive tract perforation, which was complicated by abdominal dehiscence with necrosis of the fascia. This was repaired by rotation flap reconstruction. The abdominal walls in both patients were repaired successfully without tension.
腹壁切口裂开是剖腹术的严重并发症,而带有造口的患者的筋膜裂开尤其难以处理。我们介绍了如何对 2 例带有造口的腹壁切口裂开患者进行局部皮瓣重建。1 例患者因乙状结肠憩室穿孔导致腹膜炎而行乙状结肠切除术+结肠造口术,术后发生菱形皮瓣重建修复的筋膜裂开。另 1 例患者因消化道穿孔行全胃切除术、胆囊切除术和脾切除术,术后发生回肠造口术并发症,伴有腹壁裂开和筋膜坏死,采用旋转皮瓣重建修复。这 2 例患者的腹壁均成功修复,无张力。