Al Zarouni Marwan
Department of Plastic and Reconstructive Surgery, Rashid Government Hospital, Dubai, United Arab Emirates.
Plast Reconstr Surg Glob Open. 2019 May 16;7(5):e2182. doi: 10.1097/GOX.0000000000002182. eCollection 2019 May.
Complex or recurrent abdominal wall defects may be the result of trauma, infection, tumor resection, or a previous failed attempt at closure, among other causes. This article describes a new surgical technique that better addresses these defects and provides safety and efficacy data from 26 consecutive surgeries with a 3-year follow-up.
Prospective study in 18 men and 8 women with serious abdominal wall defects, who were surgically operated on using the two-step technique, which includes a first regenerative and closure step using a vacuum device (vacuum-assisted closure), and a second reconstructive step that does not require the use of any type of surgical mesh. The safety and efficacy results were evaluated through clinical examinations and questionnaires. The severity of patient-experienced pain and both patient and surgeon satisfaction were quantified on a scale from 0 to 10 points. The statistical calculations focused on the mean (m), range (r), and percentage (%).
The mean complete surface area of the abdominal wall defects was 250.2 cm (r = 78-770 cm). The patient and surgeon satisfaction rates at the time of hospital discharge were m = 9.0 (r = 3-10) and m = 9.4 (r = 8-10), respectively. After 3 years, these rates were m = 7.2 (r = 3-10) and m = 9.8 (r = 9-10), respectively. No relevant complications were observed in any stage of the study and no recurrence was observed 3 years later. The main complaint of patients was the presence of hypertrophic scars from the surgical wound (57% of cases).
The two-step technique is an excellent alternative for the repair of complete abdominal wall defects of up to 800 cm because it allows serious complications to be avoided, prevents recurrences, and shows high rates of both patient and surgeon satisfaction.
复杂或复发性腹壁缺损可能由创伤、感染、肿瘤切除或先前的闭合尝试失败等多种原因导致。本文描述了一种新的手术技术，该技术能更好地处理这些缺损，并提供了连续26例手术且随访3年的安全性和有效性数据。
对18名男性和8名女性严重腹壁缺损患者进行前瞻性研究，采用两步技术进行手术，第一步是使用真空装置（真空辅助闭合）进行再生和闭合，第二步是重建步骤，无需使用任何类型的外科补片。通过临床检查和问卷调查评估安全性和有效性结果。患者经历的疼痛严重程度以及患者和外科医生的满意度均采用0至10分进行量化。统计计算集中在均值（m）、范围（r）和百分比（%）。
腹壁缺损的平均完整表面积为250.2平方厘米（r = 78 - 770平方厘米）。出院时患者和外科医生的满意度评分均值分别为m = 9.0（r = 3 - 10）和m = 9.4（r = 8 - 10）。3年后，这些评分均值分别为m = 7.2（r = 3 - 10）和m = 9.8（r = 9 - 10）。在研究的任何阶段均未观察到相关并发症，3年后也未观察到复发。患者的主要抱怨是手术伤口出现增生性瘢痕（57%的病例）。
两步技术是修复面积达800平方厘米的完整腹壁缺损的极佳选择，因为它能避免严重并发症，防止复发，且患者和外科医生的满意度都很高。
