Henry Cathy R, Bradburn Eric, Moyer Kurtis E
Division of Plastic Surgery, College of Medicine, The Penn State University, Hershey, PA, USA.
Ann Plast Surg. 2013 Sep;71(3):266-8. doi: 10.1097/SAP.0b013e31828a49f9.
Complex abdominal wall reconstruction (AWR) remains challenging. Techniques for repair are numerous and include primary fascial approximation, separation of components (SOC), and use of various biologic and synthetic meshes. Given the vast expanse of available techniques and lack of consistent algorithms, an analysis of outcomes in AWR is presented.
A retrospective review was performed of complex AWRs performed by 2 surgeons at a single institution from July 2008 to October of 2011. Outcome differences for hernia repairs specifically addressing SOC with an acellular dermis inlay (retrorectus), underlay, or overlay mesh, as well as interposition biologic mesh placement were included.
A total of 66 patients were identified. The average body mass index in this population was 35.5 kg/m. The average age was 53.7 years, with 62% females and 38% males. The overall rate of tobacco use history was 48%. Twenty-eight percent were diabetic. The overall hernia recurrence rate was 16%. Patients having SOC with inlay (retrorectus) mesh had a hernia recurrence rate of 9%. Hernia recurrence in those with SOC and biologic mesh reinforcement as an underlay or onlay was 12%; in those without mesh reinforcement, 22%; and for those with a biologic mesh interposition, 40%.
The results of this review show that hernia recurrence rates are decreased with primary fascial repair. Further reduction occurs when biologic mesh reinforcement is used. The lowest recurrence rates were seen in the group with SOC and a porcine biologic mesh inlay. Abdominal wall reconstruction is challenging and with continued outcomes review a refined algorithm can be achieved.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic: III.
复杂腹壁重建（AWR）仍然具有挑战性。修复技术众多，包括原发性筋膜缝合、成分分离术（SOC）以及使用各种生物和合成补片。鉴于可用技术种类繁多且缺乏一致的算法，本文对AWR的治疗结果进行分析。
对2008年7月至2011年10月在单一机构由2名外科医生实施的复杂AWR进行回顾性研究。纳入了采用脱细胞真皮植入（腹直肌后）、底层或覆盖补片专门处理SOC的疝修补术以及置入生物补片的结果差异。
共纳入66例患者。该人群的平均体重指数为35.5kg/m²。平均年龄为53.7岁，女性占62%，男性占38%。有吸烟史的总体比例为48%。28%为糖尿病患者。总体疝复发率为16%。采用植入（腹直肌后）补片的SOC患者疝复发率为9%。采用底层或覆盖生物补片加强的SOC患者疝复发率为12%；未使用补片加强的患者为22%；采用生物补片置入的患者为40%。
本综述结果表明，原发性筋膜修复可降低疝复发率。使用生物补片加强可进一步降低复发率。SOC联合猪生物补片植入组的复发率最低。腹壁重建具有挑战性，通过持续的结果评估可实现更完善的算法。
临床问题/证据级别：治疗性：III级。
