Wang Theresa Y, Elliott River, Low David W
Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
Ann Plast Surg. 2013 Mar;70(3):324-30. doi: 10.1097/SAP.0b013e3182361af9.
Damage control laparotomy has become an accepted approach for patients with life-threatening abdominal conditions. This method compromises fascial integrity creating functionally and aesthetically debilitating hernias. The purpose of this study is to present our technique and outcomes with these complex abdominal wall reconstructions.
A retrospective review was conducted on 56 patients with previous damage control laparotomies who underwent elective single-stage abdominal wall reconstruction between 1999 and 2006. Mean age was 42 years. Reconstruction consisted of a double-layer, subfascial Vicryl mesh buttress, combined with components separation and rectus muscle turnover flaps. Hernia recurrence and function were evaluated by clinical examinations and telephone surveys.
The major etiologies of abdominal hernias were gunshot wounds, motor vehicle accidents or blunt trauma, and sepsis or perforated bowel. The mean abdominal wall defect was 865 cm, and the average interval time to definitive repair was 17 months. The average length of follow-up was 29 months. Most patients (88%) had successful repair of their abdominal wall, with no hernia recurrence. There were 7 cases of hernia. Of these, 2 cases were from reopening of abdomen because of compartment syndrome that was not repaired, 3 were small asymptomatic hernias for which patients elected not to undergo further repair. Other complications include superficial skin dehiscence, all of which healed secondarily with daily wound care 12% (7 patients) and abdominal compartment syndrome 7.1% (4 patients), resulting in 2 postoperative mortalities in the initial part of the series. There were no mesh exposures, seromas, or fistulas. In all, 29% or 52% of patients were reached by telephone. Of those, 90% surveyed and who worked full-time prior to injury returned to their jobs, and 92% were functioning at premorbid activity levels.
Massive abdominal hernia following damage control laparotomy poses a great challenge to the reconstructive surgeon. This patient population is at significant risk for mortality and morbidity. We believe the use of a Vicryl mesh buttress is an important adjunctive tool in complex abdominal wall reconstruction. Functional results are excellent with most returning to work and preinjury activity levels.
损伤控制剖腹术已成为治疗危及生命的腹部疾病患者的一种公认方法。这种方法会损害筋膜完整性，导致功能性和美观性上令人衰弱的疝气。本研究的目的是介绍我们在这些复杂腹壁重建中的技术和结果。
对1999年至2006年间接受择期单阶段腹壁重建的56例曾行损伤控制剖腹术的患者进行回顾性研究。平均年龄为42岁。重建包括双层、筋膜下的维克牢尼龙网支撑，结合成分分离和腹直肌翻转皮瓣。通过临床检查和电话调查评估疝气复发情况和功能。
腹部疝气的主要病因是枪伤、机动车事故或钝器伤，以及败血症或肠穿孔。腹壁平均缺损为865平方厘米，确定性修复的平均间隔时间为17个月。平均随访时间为29个月。大多数患者（88%）腹壁修复成功，无疝气复发。有7例疝气。其中，2例是因为未修复的间隔综合征而再次开腹，3例是小的无症状疝气，患者选择不进行进一步修复。其他并发症包括浅表皮肤裂开，所有这些经每日伤口护理后均二期愈合（12%，7例患者），以及腹腔间隔综合征（7.1%，4例患者），导致该系列初期有2例术后死亡。没有网片外露、血清肿或瘘管。总共通过电话联系到了29%或52%的患者。在这些患者中，90%接受调查且受伤前全职工作的患者恢复了工作，92%的患者功能恢复到病前活动水平。
损伤控制剖腹术后的巨大腹壁疝气给重建外科医生带来了巨大挑战。这类患者有很高的死亡和发病风险。我们认为使用维克牢尼龙网支撑是复杂腹壁重建中的一种重要辅助工具。功能结果极佳，大多数患者恢复工作和伤前活动水平。
