Popa Florina, Ardelean Filip, Pestean Cosmin, Purdoiu Robert, Rosca Oana, Georgescu Alexandru
Department of Plastic Surgery, Rehabilitation Hospital, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Department of Anesthesiology and Reanimation, University of Agricultural Sciences and Veterinary Medicine, Cluj-Napoca, Romania.
Clujul Med. 2017;90(2):203-211. doi: 10.15386/cjmed-684. Epub 2017 Apr 25.
In the age of synthetic prostheses most of hernia studies include a careful examination of the various types of prosthesis, their characteristics and their repair indications. Biological prostheses are also beginning to draw attention. But in terms of recurrence especially for poor or developing countries, the discussion is different, due to their high cost which makes them difficult to afford. In this article we present new flap reconstruction techniques for the reconstruction of the abdominal wall versus mesh repair, applied on swine models, outline the results of each technique, and specify the indications for their use.
An experimental protocol using four swine models (PIC-FII-337 hybrid breed pigs), five months old, was conducted. All animal care and operative procedures were studied following the protocol approved by the Ethics Committee of the University of Medicine and Pharmacy resolution no. 281/2014 of the Department of Surgery of the University of Agricultural Sciences and Veterinary Medicine); the study was carried out between November 2015 and February 2016. The primary objective was to compare the effect of surgical strategies in the treatment of the abdominal wall defect using variable flaps versus mesh repair in a large-animal models. Physical examination and ultrasound imaging of the abdominal wall repair were done on determined periods, during one month. The complications occurring after the abdominal wall repair were edema, collections, superficial dehiscence an recurrences.
No recurrences were reported at one month results, all seromas reported were solved over time by natural drainage. Superficial necrosis appeared in two swine models and superficial dehiscence occurred in one model, the perforator "plus" flap. Mesh infection was detected in the "onlay" swine model.
In terms of recurrences, contaminated abdominal wall defects or other contraindications to the use of prosthetic materials, biological mesh repair or flap surgery are the only surgical options. Based on our findings and considering the high cost reported by the biological meshes use, flap surgery becomes the suitable treatment for such cases, allowing a good reconstruction of the abdominal wall.
在合成假体时代，大多数疝研究包括对各种类型假体的仔细检查、其特性及其修复适应症。生物假体也开始受到关注。但就复发而言，特别是对于贫穷或发展中国家，由于其成本高昂难以负担，讨论有所不同。在本文中，我们展示了用于腹壁重建的新皮瓣重建技术与网状修复技术，应用于猪模型，概述了每种技术的结果，并明确了其使用适应症。
采用四个五个月大的猪模型（PIC - FII - 337杂交品种猪）进行了一项实验方案。所有动物护理和手术程序均按照农业科学与兽医学院大学外科系医学与药学院伦理委员会批准的方案进行（决议编号281/2014）；该研究于2015年11月至2016年2月进行。主要目的是在大型动物模型中比较使用可变皮瓣与网状修复治疗腹壁缺损的手术策略的效果。在一个月内的特定时间段对腹壁修复进行体格检查和超声成像。腹壁修复后出现的并发症有水肿、积液、浅表裂开和复发。
一个月时未报告复发情况，所有报告的血清肿随时间通过自然引流得以解决。两个猪模型出现浅表坏死，一个模型即穿支“加”皮瓣出现浅表裂开。“覆盖”猪模型中检测到网状物感染。
就复发、污染的腹壁缺损或使用假体材料的其他禁忌症而言，生物网状修复或皮瓣手术是唯一的手术选择。基于我们的研究结果并考虑到使用生物网状物报告的高成本，皮瓣手术成为此类病例的合适治疗方法，可实现腹壁的良好重建。
