Suburban Surgical Associates, 555 N. New Ballas Rd., Ste. 265, St. Louis, MO, 63141, USA,
Hernia. 2014 Feb;18(1):71-9. doi: 10.1007/s10029-013-1148-x. Epub 2013 Aug 10.
Ventral abdominal wall hernias are common and repair is frequently associated with complications and recurrence. Although non-crosslinked intact porcine-derived acellular dermal matrix (PADM) has been used successfully in the repair of complex ventral hernias, there is currently no consensus regarding the type of mesh and surgical techniques to use in these patients. This report provides added support for PADM use in complex ventral hernias.
In a consecutive series of adult patients (2008-2011), complex ventral abdominal wall hernias (primary and incisional) were repaired with PADM by a single surgeon. Patient comorbidities, repair procedures, and postoperative recovery, recurrence, and complications were noted.
Forty-four patients (mean age, 57.5 years) underwent 45 single-stage ventral abdominal wall hernia repairs (3 primary; 42 incisional). Previously placed synthetic mesh was removed in 17 cases. In 40 cases, primary fascial closure was achieved; in 5 cases, PADM was used as a bridge. Vacuum-assisted closure (VAC) was used for 38/45 cases: 19 closed incisions, 16 cases using the "French fry" technique, and 3 cases with open incisions. Mean hospital stay was 8.2 days (range, 3-32) and mean follow-up was 17 months (range, 1-48). There were 4 (8.9 %) hernia recurrences, 3 requiring additional repair and 1 requiring PADM explantation. There were 3 (6.7 %) skin dehiscences, 4 (8.9 %) deep wound infections requiring drainage, and 5 (11.1 %) seromas (4 self-limited, 1 requiring drainage).
Non-crosslinked intact PADM yielded favorable early outcomes when used to repair complex ventral abdominal wall hernias in high-risk patients.
腹壁疝是常见的，修复常伴有并发症和复发。虽然非交联完整的猪源性去细胞真皮基质（PADM）已成功应用于复杂的腹壁疝修复，但目前对于这些患者使用哪种类型的网片和手术技术尚未达成共识。本报告为 PADM 在复杂腹壁疝中的应用提供了更多支持。
在一项连续的成年患者系列研究中（2008-2011 年），一位外科医生对复杂的腹壁疝（原发性和切口疝）使用 PADM 进行了单一阶段修复。记录患者的合并症、修复程序以及术后恢复、复发和并发症情况。
44 名患者（平均年龄 57.5 岁）接受了 45 例单一阶段的腹壁疝修复（3 例原发性；42 例切口疝）。17 例病例中移除了先前放置的合成网片。在 40 例病例中实现了原发性筋膜闭合；在 5 例病例中，PADM 用作桥接。38/45 例病例使用了真空辅助闭合（VAC）：19 例闭合切口，16 例使用“法式薯条”技术，3 例开放切口。平均住院时间为 8.2 天（范围 3-32 天），平均随访时间为 17 个月（范围 1-48 个月）。有 4 例（8.9%）疝复发，3 例需要再次修复，1 例需要 PADM 取出。有 3 例（6.7%）皮肤裂开，4 例（8.9%）深部伤口感染需要引流，5 例（11.1%）血清肿（4 例自行消退，1 例需要引流）。
在高风险患者中，使用非交联完整的 PADM 修复复杂的腹壁疝可获得早期良好的结果。
