Davis John, Caruso Daniel M, Foster Kevin N, Matthews Marc R
Department of Surgery, Maricopa Integrated Health System, Phoenix, AZ.
Arizona Burn Center, Department of Surgery, Maricopa Integrated Health System, Phoenix, AZ.
J Burn Care Res. 2018 Aug 17;39(5):838-842. doi: 10.1097/BCR.0000000000000615.
The open abdomen is a well-known technique that is applied in a wide variety of clinical situations, including treatment of abdominal compartment syndrome, damage control laparotomy, and severe intraabdominal sepsis. Disease states such as Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis or extensive deep partial and/or full-thickness torso burns involving the abdomen often result in a complete epidermal and partial dermal loss. When ABThera Open Abdomen Negative Pressure Wound Therapy is attempted in these patients, the exposed subcutaneous tissue rarely allows for an adequate seal between the adhesive barrier and the denuded skin. This is because successful placement of negative pressure wound therapy device necessitates having a dry epidermal surface allowing the adhesive tape to actually adhere. The ABThera Open Abdomen Negative Pressure Wound Therapy visceral protective layer was placed over the exposed bowel, followed by the blue perforated foam interface and then the adhesive barrier drape. Over the top of the "less-than-air-tight" adhesive barrier drape was placed a standard isolation transport bowel bag, which was stapled to the dermis, but outside of the previously placed adhesive barrier drape's diameter to "bolster" the adhesive barrier drape, only allowing the suction tube to extend inferiorly. This ABThera Open Abdomen Negative Pressure Wound Therapy ABNPWT held suction, even during multiple adjacent dressing changes, despite the exposed dermis. This case report reveals a unique approach that solves the issue of inadequate seal due to extensive burns to the torso and has significant benefit in burn and wound care practices.
开放性腹部是一种广为人知的技术，应用于多种临床情况，包括治疗腹腔间隔室综合征、损伤控制剖腹术和严重的腹腔内脓毒症。诸如史蒂文斯-约翰逊综合征/中毒性表皮坏死松解症等疾病状态，或涉及腹部的广泛深度部分和/或全层躯干烧伤，常常导致表皮完全缺失和部分真皮缺失。当在这些患者中尝试使用ABThera开放性腹部负压伤口治疗时，暴露的皮下组织很少能使粘性屏障与裸露皮肤之间形成足够的密封。这是因为负压伤口治疗装置的成功放置需要有干燥的表皮表面，以便胶带能够真正粘附。将ABThera开放性腹部负压伤口治疗内脏保护层放置在暴露的肠管上，接着是蓝色多孔泡沫界面，然后是粘性屏障单。在“气密性不足”的粘性屏障单上方放置一个标准的隔离运输肠袋，将其 stapled 到真皮上，但在先前放置的粘性屏障单的直径范围之外，以“支撑”粘性屏障单，仅允许吸管向下延伸。尽管存在裸露的真皮，但这种ABThera开放性腹部负压伤口治疗（ABNPWT）即使在多次相邻敷料更换期间仍能保持吸力。本病例报告揭示了一种独特的方法，可解决因躯干广泛烧伤导致的密封不足问题，并且在烧伤和伤口护理实践中具有显著益处。
“stapled”这个词在医学语境中比较难准确翻译，可能是一种特殊的医学操作，这里暂保留英文表述。
