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复杂腹壁重建联合成分离术及猪脱细胞真皮基质强化后的适应证及治疗结果

Indications and outcomes following complex abdominal reconstruction with component separation combined with porcine acellular dermal matrix reinforcement.

作者信息

Patel Ketan M, Nahabedian Maurice Y, Gatti Margaret, Bhanot Parag

机构信息

Department of Plastic Surgery, Georgetown University Hospital, Georgetown University, Washington DC 20007, USA.

出版信息

Ann Plast Surg. 2012 Oct;69(4):394-8. doi: 10.1097/SAP.0b013e31822f997b.

Abstract

PURPOSE

Component separation (CS) is an effective technique for complex abdominal wall reconstruction (AWR). Reinforcement of the repair with mesh can add durability. The purpose of this study was to evaluate the indications and outcomes following CS combined with a porcine acellular dermal matrix (PADM) for reinforcement.

METHODS

A retrospective review of all patients who underwent complex AWR at the authors' institution was completed between 2007 and 2010. Patients with complex hernias who underwent CS in conjunction with PADM as an underlay were included. The PADM used in this cohort was Strattice (LifeCell Corporation, Branchburg, NJ). Patient demographics, indications, perioperative details, postoperative care, and long-term outcomes were reviewed.

RESULTS

A total of 78 patients were identified as having PADM implanted for AWR. Of this cohort, 41 patients met the criteria as having a CS to achieve midline closure, with the PADM placed as reinforcement in an underlay manner. These patients were classified as grade II (33; 80.5%), grade III (4; 9.8%), and grade IV (4; 9.8%). Average patient age was 57.6 years (range, 33-80), and average body mass index (BMI) was 35.8 kg/m2 (range, 21.6-52.1). Patient comorbidities included coronary artery disease (19; 46.3%), diabetes mellitus (14; 34.2%), chronic obstructive pulmonary disease (COPD) (6; 14.6%), and chronic steroid use (2; 4.9%). Previous mesh infection occurred in 9 (28.1%). The mean defect diameter was found to be 14.3 cm. Perforator preservation of the subcutaneous flaps was performed in 34 (82.9%) patients. A concomitant panniculectomy was performed in 9 (22%) patients. A staged approach was used in 3 (7.3%) patients. The overall complication rate was 24.4%. Strattice exposure occurred in 5 (12.2%) patients. All patients went on to heal wounds without explantation.No hernia recurrences or symptomatic bulges were observed in the follow-up period of 474 days (range, 194-1017 days). No significant predictors of complications were identified.

CONCLUSIONS

Strattice is an effective adjunct to AWR when used as reinforcement during CS for a wide variety of indications. Complication rates remain low in complex patients. In addition, Strattice appears to add durability to midline reconstructions with no recurrences during the follow-up period.

摘要

目的

组织分离术(CS)是复杂腹壁重建(AWR)的一种有效技术。用补片加强修复可增加其耐用性。本研究的目的是评估CS联合猪脱细胞真皮基质(PADM)进行加强的适应证及效果。

方法

对2007年至2010年在作者所在机构接受复杂AWR的所有患者进行回顾性研究。纳入接受CS并联合使用PADM作为衬层的复杂疝患者。本队列中使用的PADM是Strattice(LifeCell公司,新泽西州布兰奇堡)。回顾患者的人口统计学资料、适应证、围手术期细节、术后护理及长期效果。

结果

共78例患者因AWR植入了PADM。在这个队列中,41例患者符合采用CS实现中线闭合的标准,将PADM作为衬层加强材料植入。这些患者分为Ⅱ级(33例;80.5%)、Ⅲ级(4例;9.8%)和Ⅳ级(4例;9.8%)。患者平均年龄为57.6岁(范围33 - 80岁),平均体重指数(BMI)为35.8 kg/m²(范围21.6 - 52.1)。患者的合并症包括冠状动脉疾病(19例;46.3%)、糖尿病(14例;34.2%)、慢性阻塞性肺疾病(COPD)(6例;14.6%)和长期使用类固醇(2例;4.9%)。既往有补片感染的患者有9例(28.1%)。发现平均缺损直径为14.3 cm。34例(82.9%)患者在皮下瓣中保留了穿支。9例(22%)患者同时进行了腹壁成形术。3例(7.3%)患者采用了分期手术。总体并发症发生率为24.4%。5例(12.2%)患者出现Strattice暴露。所有患者伤口均愈合,无需取出补片。在474天(范围194 - 1017天)的随访期内未观察到疝复发或有症状的隆起。未发现并发症的显著预测因素。

结论

当Strattice在CS期间作为加强材料用于多种适应证时,它是AWR的一种有效辅助材料。复杂患者的并发症发生率仍然较低。此外,Strattice似乎增加了中线重建的耐用性,随访期间无复发。

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