Saman Masoud, Kadakia Sameep, Ducic Yadranko
Department of Otolaryngology-Head and Neck Surgery, Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX, USA.
Department of Otolaryngology-Head and Neck Surgery, The New York Eye and Ear Infirmary, 310 East 14th ST, 6th Floor, New York, NY, 10003, USA.
Oral Maxillofac Surg. 2015 Dec;19(4):347-51. doi: 10.1007/s10006-015-0498-1. Epub 2015 Apr 26.
Patients with rectus free flap harvest extending below the arcuate line are predisposed to postoperative hernia formation. As such, many authors have advocated the use of closure adjuncts to increase the integrity of the closure and prevent hernia or abdominal wall bulging.
Busy level 1 public trauma center in metropolitan Fort Worth, Texas
Following harvest of the rectus free flap, 48 patients underwent primary closure; 24 of these patients had defects extending below the arcuate line. Forty patients were closed with an acellular dermal graft; 22 of these patients had defects extending below the arcuate line.
Postoperative hernia formation and local infection rate were examined in a minimum follow-up period of 1 year.
Regardless of closure method, no hernias were observed in the postoperative period. Using an unpaired t test and an alpha value of 0.05, there was no statistically significant difference in the infection rate between the two groups.
Following rectus abdominis myocutaneous free flap harvest, the use of an acellular dermal graft in abdominal wall closure may not be of any further advantage in the prevention of hernia.
Retrospective (Level III).
腹直肌游离皮瓣切取范围延伸至弓状线以下的患者术后易发生疝形成。因此，许多作者主张使用闭合辅助材料来增强闭合的完整性，预防疝或腹壁膨出。
得克萨斯州沃思堡市繁忙的一级公立创伤中心
在切取腹直肌游离皮瓣后，48例患者接受了一期闭合；其中24例患者的缺损延伸至弓状线以下。40例患者使用脱细胞真皮移植物进行闭合；其中22例患者的缺损延伸至弓状线以下。
在至少1年的随访期内检查术后疝形成情况和局部感染率。
无论采用何种闭合方法，术后均未观察到疝。使用不成对t检验，α值为0.05，两组之间的感染率无统计学显著差异。
在切取腹直肌肌皮游离皮瓣后，使用脱细胞真皮移植物进行腹壁闭合在预防疝方面可能没有进一步的优势。
回顾性研究（III级）。
