Sbitany Hani, Kwon Edwin, Chern Hueylan, Finlayson Emily, Varma Madhulika G, Hansen Scott L
From the Divisions of *Plastic and Reconstructive Surgery, and †Colorectal Surgery, University of California, San Francisco, San Francisco, CA.
Ann Plast Surg. 2015 Aug;75(2):201-4. doi: 10.1097/SAP.0000000000000030.
Repair of grade 3 and grade 4 ventral hernias is a distinct challenge, given the potential for infection, and the comorbid nature of the patient population. This study evaluates our institutional outcomes when performing single-stage repair of these hernias, with biologic mesh for abdominal wall reinforcement.
A prospectively maintained database was reviewed for all patients undergoing repair of grade 3 (potentially contaminated) or grade 4 (infected) hernias, as classified by the Ventral Hernia Working Group. All those patients undergoing repair with component separation techniques and biologic mesh reinforcement were included. Patient demographics, comorbidities, and postoperative complications were analyzed. Univariate analysis was performed to define factors predictive of hernia recurrence and wound complications.
A total of 41 patients underwent single-stage repair of grade 3 and grade 4 hernias during a 4-year period. The overall postoperative wound infection rate was 15%, and hernia recurrence rate was 12%. Almost all recurrences were seen in grade 4 hernia repairs, and in those patients undergoing bridging repair of the hernia. One patient required removal of the biologic mesh. Those factors predicting hernia recurrence were smoking (P = 0.023), increasing body mass index (P = 0.012), increasing defect size (P = 0.010), and bridging repair (P = 0.042). No mesh was removed due to perioperative infection. Mean follow-up time for this patient population was 25 months.
Single-stage repair of grade 3 hernias performed with component separation and biologic mesh reinforcement is effective and offers a low recurrence rate. Furthermore, the use of biologic mesh allows for avoidance of mesh explantation in instances of wound breakdown or infection. Bridging repairs are associated with a high recurrence rate, as is single-stage repair of grade 4 hernias.
鉴于存在感染风险以及患者群体的共病性质，3级和4级腹疝的修复是一项独特的挑战。本研究评估了我们机构在使用生物补片进行腹壁加强的情况下对这些疝进行一期修复的效果。
回顾前瞻性维护的数据库，纳入所有接受腹疝工作组分类为3级（潜在污染）或4级（感染）疝修补术的患者。所有采用组织分离技术和生物补片加强修补的患者均纳入研究。分析患者的人口统计学特征、共病情况和术后并发症。进行单因素分析以确定预测疝复发和伤口并发症的因素。
在4年期间，共有41例患者接受了3级和4级疝的一期修复。术后总体伤口感染率为15%，疝复发率为12%。几乎所有复发都见于4级疝修补术以及采用疝桥接修补术的患者。1例患者需要取出生物补片。预测疝复发的因素包括吸烟（P = 0.023）、体重指数增加（P = 0.012）、缺损尺寸增大（P = 0.010）和桥接修补（P = 0.042）。没有因围手术期感染而取出补片。该患者群体的平均随访时间为25个月。
采用组织分离和生物补片加强进行3级疝的一期修复是有效的，且复发率低。此外，使用生物补片可避免在伤口裂开或感染时取出补片。桥接修补术与高复发率相关，4级疝的一期修复也是如此。
