Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, NY, USA.
Division of Plastic and Reconstructive Surgery, Columbia University Medical Center, New York, NY, USA.
Surg Endosc. 2021 May;35(5):2049-2058. doi: 10.1007/s00464-020-07601-9. Epub 2020 May 8.
Poly-4-hydroxybutyric acid (P4HB, Phasix™) is a biosynthetic polymer that degrades by hydrolysis that can be woven into a mesh for use in soft tissue reinforcement. Herein, we describe our initial experience performing complex abdominal wall repair (CAWR) utilizing component separation and P4HB mesh as onlay reinforcement.
All patients undergoing CAWR between June 2014 and May 2017 were followed prospectively for postoperative outcomes. Only those patients who underwent components separation with primary repair of the fascial edges followed by onlay of P4HB mesh were included in this study.
105 patients (52 male, 53 female; mean age 59.2 years, range 22-84) met inclusion criteria. Mean BMI was 29.1 (range 16-48); 52% patients had prior attempted hernia repair, most with multiple medical comorbidities (71% of patients with ASA 3 or greater). 30% of cases were not clean at the time of repair (CDC class 2 or greater). Median follow-up was 36 months (range 9-63). Eighteen patients (17%) developed a hernia recurrence ranging from 2 to 36 months postoperatively. Five (5%) patients developed a localized superficial infection treated with antibiotics, three (2.8%) required re-operation for non-healing wounds, and six (6%) patients developed seroma.
These data demonstrate a relatively low rate of hernia recurrence, seroma, and other common complications of CAWR in a highly morbid patient population. Importantly, the rate of mesh infection was low and no patients required complete mesh removal, even when placed into a contaminated or infected surgical field.
聚-4-羟基丁酸酯（P4HB，Phasix™）是一种可水解降解的生物合成聚合物，可编织成网用于软组织增强。在此，我们介绍了使用组件分离和 P4HB 网片作为覆盖增强进行复杂腹壁修复（CAWR）的初步经验。
所有 2014 年 6 月至 2017 年 5 月期间接受 CAWR 的患者均进行前瞻性随访以评估术后结果。只有那些接受了组件分离术、筋膜边缘一期修复、随后行 P4HB 网片覆盖增强的患者被纳入本研究。
105 例患者（52 例男性，53 例女性；平均年龄 59.2 岁，范围 22-84 岁）符合纳入标准。平均 BMI 为 29.1（范围 16-48）；52%的患者曾行疝修补术尝试，大多数患者存在多种合并症（71%的患者 ASA 分级为 3 级或以上）。30%的病例在修复时为非清洁（CDC 分级 2 级或以上）。中位随访时间为 36 个月（范围 9-63）。18 例（17%）患者在术后 2-36 个月发生疝复发。5 例（5%）患者发生局部浅表感染，经抗生素治疗后痊愈，3 例（2.8%）患者因伤口不愈合需再次手术，6 例（6%）患者发生血清肿。
这些数据表明，在高病态患者人群中，CAWR 的疝复发、血清肿和其他常见并发症的发生率相对较低。重要的是，即使放置在污染或感染的手术部位，网片感染的发生率也较低，且无患者需要完全取出网片。
