Zerbib P, Caiazzo R, Piessen G, Rogosnitzky M, Séquier C, Koriche D, Truant S, Boleslawski E, Chambon J P, Pruvot F R
Department of General Surgery and Transplantation, CHU, Université Nord de France, 59000, Lille, France,
Hernia. 2015 Apr;19(2):253-7. doi: 10.1007/s10029-013-1153-0. Epub 2013 Sep 19.
Management of infected abdominal wall defects is a subject of debate, and the use of prosthetic mesh repair is not recommended due to the dramatic rate of mesh infection. The aim of this prospective study was to determine the recurrence rate and long-term outcomes of repairing infected abdominal wall defects using the Strattice porcine acellular dermal matrix reinforcement through a single-stage surgical approach.
From August 2010 to May 2012, consecutive patients treated for infected abdominal wall defects using Strattice, a biologic prosthesis, were enrolled. All data were collected prospectively and all patients were followed for physical examination and CT scan evaluation. The primary outcome measure was the recurrence rate.
Eighteen patients were enrolled and 14 were evaluable. Of these, eight patients had mesh infections and six had enterocutaneous fistulas. Median follow-up was 13 months (range, 3-22) and median length of hospitalization was 13 days (range, 4-56). The Strattice was placed in the intraperitoneal underlay position in 12 patients, and in the retro-rectus position for two. Post-operative complications included skin dehiscence (n = 3), wound infection (n = 2), skin necrosis (n = 1), and seroma (n = 2). At the end of follow-up, six patients (43 %) experienced abdominal wall defect recurrence.
The utility of biologic prostheses to repair infected abdominal wall defects is controversial; however, currently, they remain the only alternative to a two-staged surgery. Prospective, randomized studies in larger populations of patients are necessary to fully determine the usefulness of biologic prostheses in this setting.
感染性腹壁缺损的处理存在争议，由于人工补片感染率极高，不建议使用人工补片进行修复。本前瞻性研究的目的是通过单阶段手术方法，使用Strattice猪脱细胞真皮基质补片来修复感染性腹壁缺损，以确定其复发率和长期疗效。
纳入2010年8月至2012年5月间连续使用生物补片Strattice治疗感染性腹壁缺损的患者。所有数据均前瞻性收集，所有患者均接受体格检查和CT扫描评估。主要观察指标为复发率。
共纳入18例患者，其中14例可进行评估。这些患者中，8例发生补片感染，6例发生肠皮肤瘘。中位随访时间为13个月（范围3 - 22个月），中位住院时间为13天（范围4 - 56天）。12例患者的Strattice补片置于腹膜内下层位置，2例置于腹直肌后位。术后并发症包括皮肤裂开（3例）、伤口感染（2例）、皮肤坏死（1例）和血清肿（2例）。随访结束时，6例患者（43%）出现腹壁缺损复发。
生物补片修复感染性腹壁缺损的效用存在争议；然而，目前它们仍是两阶段手术的唯一替代方案。需要在更多患者群体中进行前瞻性、随机研究，以充分确定生物补片在此情况下的有用性。
