Department of General and Digestive Surgery, La Mancha-Centro General Hospital, Avenida de la Constitución, 3, 13600, Alcázar de San Juan, Ciudad Real, Spain.
J Gastrointest Surg. 2013 Sep;17(9):1665-72. doi: 10.1007/s11605-013-2285-3. Epub 2013 Jul 19.
The components separation technique has been proposed as the best solution when facing large abdominal wall defects. In counterpart, this sometimes comes at the price of high rates of wound complications and recurrence. Moreover, the components separation method alone seems insufficient for huge defects, in which it is impossible to reapproximate the rectus muscles without tension. For these cases, we illustrate a novel operation using a modified components separation technique.
Twenty-eight patients with giant midline incisional hernias were treated with a combination of the components separation (bilateral sliding rectus abdominis advancement flaps), an autologous multilayer repair, and a retromuscular mesh reinforcement.
Twenty-four (85%) patients have been analyzed. Transverse defect size ranged from 15 to 25 cm (average, 18.8 cm). Wound complications occurred in nine (37%) cases; three of them required drainage of a subcutaneous abscess. After a mean follow-up of 22 (range, 12-48) months, one (4%) recurrence was identified.
Multilayer myofascial-mesh repair was associated with a low recurrence rate, and wound complications were managed without issues. This approach is a reliable technique for most surgeons and may constitute a new part of the armamentarium for the repair of challenging defects.
当面临大的腹壁缺损时，分离技术被认为是最佳解决方案。但这也带来了较高的伤口并发症和复发率。此外，单独使用组件分离方法对于巨大的缺陷似乎还不够，因为在没有张力的情况下，无法重新接近腹直肌。对于这些情况，我们使用改良的组件分离技术来演示一种新的手术。
28 例巨大中线切口疝患者采用组件分离（双侧滑动腹直肌前进步伐皮瓣）、自体多层修复和肌后网片加强相结合的方法进行治疗。
24 例（85%）患者得到分析。横断缺损大小为 15-25cm（平均 18.8cm）。9 例（37%）发生伤口并发症，其中 3 例需要引流皮下脓肿。平均随访 22 个月（范围 12-48 个月）后，发现 1 例（4%）复发。
多层肌筋膜网片修复与低复发率相关，且伤口并发症处理无问题。这种方法对大多数外科医生来说是一种可靠的技术，可能成为修复挑战性缺陷的新手段。
