Dvision of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota.
Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
Microsurgery. 2020 Jan;40(1):19-24. doi: 10.1002/micr.30374. Epub 2018 Sep 3.
Reconstruction of abdominal wall defects with enterocutaneous fistulas (ECF) remains challenging. The purpose of this report is to describe a single-stage approach using combined microscopic enterolysis, pedicle seromuscular bowel flaps, mesh, fasciocutaneous, and myocutaneous flaps.
Between 1990 and 2016 a retrospective review identified a total of 18 patients with an average age of 39 years (ranging 26-59 years). Thirteen cases were associated with trauma, four were complication of previous mesh repair, and one was after an aortic dissection. Average diameter of defect size was 22 cm (ranging 20-24 cm). Surgical technique involved enterolysis using microscope magnification, a pedicle seromuscular bowel flap to reinforce the bowel anastomosis, mesh, musculocutaneous, and fasciocutaneous flaps to reconstruct the abdominal wall.
Fifteen patients required rotational flaps with an average skin paddle area of 442.7 cm (ranging 440 cm -260 cm ) and 10 patients required a serosal patch with an average length of 5 cm (ranging 4-6 cm). Complications included three wound dehiscence and one abdominal wall bulging. Flap survival was 100%. The majority of patients (12 out of 18) were able to resume normal activities, and the remaining (n = 6) were able to resume most activities. Functional outcome as assessed by 36-Item Short Form Survey (SF-36) physical function component questionnaire at 18-24 months follow up was 67.8% (ranging from 59 to 72%). Mean length of hospital stay was 2.2 weeks (ranging 1.4-2.7 weeks). Mean follow-up was 24 months (ranging 22-26 months) with clinical examination.
Microscopically assisted intra-abdominal dissection with resection of diseased bowel, replacement with well-vascularized tissue at the anastomosis site in, and reinforcement with mesh combined with pedicle musculocutaneous and fasciocutaneous flaps may be an alternative when other local reconstructive options have failed.
带有肠外瘘（ECF）的腹壁缺损的重建仍然具有挑战性。本报告的目的是描述一种使用联合显微镜下肠松解术、带蒂浆肌肠瓣、网片、筋膜皮瓣和肌皮瓣的单阶段方法。
在 1990 年至 2016 年期间，通过回顾性研究共确定了 18 例患者，平均年龄为 39 岁（26-59 岁）。13 例与创伤有关，4 例与先前的网片修复并发症有关，1 例与主动脉夹层有关。缺损大小的平均直径为 22cm（20-24cm）。手术技术包括显微镜放大下的肠松解术、带蒂浆肌肠瓣加强肠吻合口、网片、肌皮瓣和筋膜皮瓣重建腹壁。
15 例患者需要旋转皮瓣，平均皮瓣面积为 442.7cm（440cm-260cm），10 例患者需要使用浆膜贴片，平均长度为 5cm（4-6cm）。并发症包括 3 例伤口裂开和 1 例腹壁膨出。皮瓣存活率为 100%。大多数患者（18 例中的 12 例）能够恢复正常活动，其余 6 例（n=6）能够恢复大部分活动。通过 36 项简明健康调查问卷（SF-36）身体功能部分问卷评估，18-24 个月的随访结果显示，功能结局为 67.8%（59-72%）。平均住院时间为 2.2 周（1.4-2.7 周）。平均随访时间为 24 个月（22-26 个月），并进行了临床检查。
显微镜辅助的腹腔内解剖，切除病变肠管，在吻合部位用血管丰富的组织置换，并辅以网片和带蒂肌皮瓣和筋膜皮瓣，可能是其他局部重建方法失败时的一种替代方法。
