Wooten Kimberly E, Ozturk Cemile Nurdan, Ozturk Can, Laub Peter, Aronoff Nell, Gurunluoglu Raffi
Department of Head, Neck and Plastic Surgery, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, USA.
Department of Head, Neck and Plastic Surgery, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, USA.
J Plast Reconstr Aesthet Surg. 2017 Jun;70(6):741-751. doi: 10.1016/j.bjps.2017.02.018. Epub 2017 Feb 28.
Tissue expanders (TEs) can be used to assist primary closure of complicated hernias and large abdominal wall defects. However, there is no consensus regarding the optimal technique, use, or associated risk of TE in abdominal wall reconstruction.
A systematic search of PubMed and Embase databases was conducted to identify articles reporting abdominal wall reconstruction with TE techniques. English articles published between 1980 and 2016 were included on the basis of the following inclusion criteria: two-stage TE surgical technique, >3 cases, reporting of postoperative complications, hernia recurrence, and patient-based clinical data.
Fourteen studies containing 103 patients (85 adults and 18 children) were identified for analysis. Most patients presented with a skin-grafted ventral hernia (n = 86). The etiology of the hernia was from trauma or prior abdominal surgery. The remaining patients had TE placed before organ transplantation (n = 12) or for congenital abdominal wall defects (n = 5). The location for expander placement was subcutaneous (n = 74), between the internal and external obliques (n = 26), posterior to the rectus sheath (n = 2), and intra-peritoneal (n = 1). Postoperative infections and implant-related problems were the most commonly reported complications after Stage I. The most common complication after Stage II was recurrent hernia, which was observed in 12 patients (11.7%). Five patients with TE died. Complications and mortality were more prevalent in children, immunosuppressed patients, and those with chronic illnesses.
Tissue expansion for abdominal wall reconstruction can be successfully used for a variety of carefully selected patients with an acceptable complication and risk profile.
组织扩张器（TEs）可用于辅助复杂疝和大腹壁缺损的一期缝合。然而，关于TE在腹壁重建中的最佳技术、使用方法或相关风险尚无共识。
对PubMed和Embase数据库进行系统检索，以确定报告使用TE技术进行腹壁重建的文章。纳入1980年至2016年间发表的英文文章，依据以下纳入标准：两阶段TE手术技术、超过3例病例、术后并发症报告、疝复发情况以及基于患者的临床数据。
确定了14项研究，共103例患者（85例成人和18例儿童）用于分析。大多数患者表现为植皮的腹疝（n = 86）。疝的病因是创伤或既往腹部手术。其余患者在器官移植前放置TE（n = 12）或用于先天性腹壁缺损（n = 5）。扩张器放置的位置为皮下（n = 74）、腹内斜肌与腹外斜肌之间（n = 26）、腹直肌鞘后方（n = 2）和腹腔内（n = 1）。术后感染和与植入物相关的问题是I期手术后最常报告的并发症。II期手术后最常见的并发症是复发性疝，12例患者（11.7%）出现该情况。5例使用TE的患者死亡。并发症和死亡率在儿童、免疫抑制患者以及患有慢性疾病的患者中更为普遍。
腹壁重建的组织扩张可成功用于各种经过精心挑选的患者，其并发症和风险情况可接受。
