1Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603 Japan.
2Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574 Japan.
World J Emerg Surg. 2018 Sep 4;13:39. doi: 10.1186/s13017-018-0200-7. eCollection 2018.
In a previous study, we reported the usefulness of early abdominal wall reconstruction using bilateral anterior rectus abdominis sheath turnover flap method (turnover flap method) in open abdomen (OA) patients in whom early primary fascial closure was difficult to achieve. However, the long-term outcomes have not been elucidated. In the present study, we aimed to evaluate the procedure, particularly in terms of ventral hernia, pain, and daily activities.
Between 2001 and 2013, 15 consecutive patients requiring OA after emergency laparotomy and in whom turnover flap method was applied were retrospectively identified. The long-term outcomes were evaluated based on medical records, physical examinations, CT imaging, and a ventral hernia pain questionnaire (VHPQ).
The turnover flap method was applied in 2 trauma and 13 non-trauma patients.In most of cases, primary fascial closure could not be achieved due to massive visceral edema. The turnover flap method was performed for abdominal wall reconstruction at the end of OA. The median duration of OA was 6 (range 1-42) days. One of the 15 patients died of multiple organ failure during initial hospitalization after the performance of the turnover flap method. Fourteen patients survived, and although wound infection was observed in 3 patients, none showed enteric fistula, abdominal abscess, graft infection, or ventral hernia during hospitalization. However, it was found that 1 patient developed ventral hernia during follow-up at an outpatient visit. Nine of 14 patients were alive and able to be evaluated with a VHPQ (follow-up period: median 10 years; range 3-15 years). Seven out of nine patients were satisfied with this procedure, and none complained of pain or were limited in their daily activities.
Based on the results of this study, early abdominal reconstruction using the turnover flap method can be considered to be safe and effective as an alternative technique for OA patients in whom primary fascial closure is considered difficult to achieve.
在之前的一项研究中，我们报告了在早期难以实现原发性筋膜闭合的情况下，使用双侧前腹直肌鞘翻转皮瓣法（翻转皮瓣法）进行开放性腹部（OA）患者早期腹壁重建的有效性。然而，其长期结果尚未阐明。在本研究中，我们旨在评估该手术，特别是在腹疝、疼痛和日常活动方面的效果。
回顾性分析 2001 年至 2013 年间 15 例因急诊剖腹术需要 OA 且应用翻转皮瓣法的连续患者。根据病历、体格检查、CT 成像和腹疝疼痛问卷（VHPQ）评估长期结果。
翻转皮瓣法应用于 2 例创伤和 13 例非创伤患者。由于大量内脏水肿，大多数患者无法实现原发性筋膜闭合。在 OA 结束时进行了腹壁重建。OA 的中位时间为 6 天（范围 1-42 天）。在进行翻转皮瓣法后，15 例患者中的 1 例因多器官功能衰竭死亡。14 例患者存活，虽然 3 例患者出现伤口感染，但在住院期间均未出现肠瘘、腹部脓肿、移植物感染或腹疝。然而，在门诊随访中发现 1 例患者出现腹疝。14 例存活患者中有 9 例接受了 VHPQ 评估（随访时间：中位数 10 年；范围 3-15 年）。9 例中有 7 例对该手术满意，无 1 例抱怨疼痛或日常生活受限。
基于本研究结果，对于认为原发性筋膜闭合困难的 OA 患者，早期使用翻转皮瓣法进行腹部重建可被认为是一种安全有效的替代技术。
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