Schardey Hans M, Di Cerbo Francesca, von Ahnen Thomas, von Ahnen Martin, Schopf Stefan
Department of General, Visceral and Vascular Surgery, Agatharied Academic Teaching Hospital of the Ludwig Maximilians University, Norbert Kerkel Platz, D 83734 Agatharied, Germany.
J Med Case Rep. 2014 Jul 11;8:251. doi: 10.1186/1752-1947-8-251.
Synthetic mesh has been used traditionally to repair abdominal wall defects, but its use is limited in the case of bacterial contamination. New biological materials are now being used successfully for delayed primary closure of contaminated abdominal wall defects. The costs of biological materials may prevent surgeons from using them. We compared the conventional staged repair of contaminated abdominal wall defects with a single-stage procedure using a non-crosslinked porcine acellular dermal matrix.
A total of 14 cases with Grade 3 contaminated abdominal wall defects underwent delayed primary closure of the abdomen using a non-crosslinked porcine acellular dermal matrix (Strattice™ Reconstructive Tissue Matrix, LifeCell Corp., Branchburg, NJ, USA). The results were compared with a group of 14 patients who had received conventional treatment for the repair of contaminated abdominal wall defects comprising a staged repair during two separate hospital admissions employing synthetic mesh. Treatment modalities, outcomes, and costs were compared.
In all cases treated with delayed primary closure employing non-crosslinked porcine acellular dermal matrix, there were no complications related to its use. Two patients died due to unrelated events. Although treatment costs were estimated to be similar in the two groups, the patients treated with porcine acellular dermal matrix spent less time as an inpatient than those receiving conventional two-stage repair.
Delayed primary closure of contaminated abdominal wall defects using a non-crosslinked porcine acellular dermal matrix may be a suitable alternative to conventional staged repair. In our patients, it resulted in early restoration of abdominal wall function and shorter hospitalization. The costs for treating contaminated abdominal wall defects using porcine acellular dermal matrix during a single hospital admission were not higher than costs for conventional two-stage repair. Further randomized studies are needed to expand upon these findings.
传统上一直使用合成网片修复腹壁缺损，但在细菌污染的情况下其应用受到限制。新型生物材料现正成功用于污染腹壁缺损的延迟一期缝合。生物材料的成本可能会阻碍外科医生使用它们。我们将污染腹壁缺损的传统分期修复与使用非交联猪脱细胞真皮基质的一期手术进行了比较。
总共14例3级污染腹壁缺损患者使用非交联猪脱细胞真皮基质（Strattice™ 重建组织基质，美国新泽西州布兰奇堡市LifeCell公司）进行腹部延迟一期缝合。将结果与一组14例接受污染腹壁缺损修复传统治疗的患者进行比较，传统治疗包括在两次单独住院期间采用合成网片进行分期修复。比较了治疗方式、结果和成本。
在所有采用非交联猪脱细胞真皮基质进行延迟一期缝合治疗的病例中，未出现与使用该材料相关的并发症。两名患者因无关事件死亡。虽然估计两组的治疗成本相似，但使用猪脱细胞真皮基质治疗的患者住院时间比接受传统两期修复的患者短。
使用非交联猪脱细胞真皮基质对污染腹壁缺损进行延迟一期缝合可能是传统分期修复的合适替代方法。在我们的患者中，它导致腹壁功能早期恢复且住院时间缩短。在单次住院期间使用猪脱细胞真皮基质治疗污染腹壁缺损的成本不高于传统两期修复的成本。需要进一步的随机研究来扩展这些发现。
