Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA.
Surg Endosc. 2021 Aug;35(8):4624-4631. doi: 10.1007/s00464-020-07888-8. Epub 2020 Aug 14.
Anterior component separation (ACS) is a well-established, highly functional technique to achieve fascial closure in complex abdominal wall reconstruction (AWR). Unfortunately, ACS is also associated with an increased risk of wound complications. Perforator sparing ACS (PS-ACS) has more recently been introduced to maintain the subcutaneous perforators derived from the deep epigastric vessels. The aim of this study is to evaluate wound-related outcomes in patients undergoing open AWR after implementation of a PS-ACS technique.
A prospectively collected database were queried for patients who underwent open AWR and an ACS from 2006 to 2018. Patients who underwent PS-ACS were compared to patients undergoing ACS using standard statistical methods. Patients undergoing concomitant panniculectomy were included in the standard ACS group.
In total, 252 patients underwent ACS, with 24 (9.5%) undergoing PS-ACS. Age and specific comorbidities were similar between groups (all p > 0.05) except for the PS-ACS groups having a higher rate of prior tobacco use (45.8% vs 19.6%, p = 0.003). Mean hernia defect area was 381.6 ± 267.0 cm with 64.3% recurrent hernias, and both were similar between groups (all p > 0.05). The PS-ACS group did have more complex wounds with more Ventral Hernia Working Group Grade 3 and 4 hernias (p = 0.04). OR time and length of stay were similar between groups (all p > 0.05). Despite increased complexity, wound complication rates were much lower in the PS-ACS group (20.8% vs 46.1%, p = 0.02), and all specific wound complications were lower but not statistically different. Hernia recurrence rate was similar between PS-ACS and ACS groups (4.2% vs 7.0%, p > 0.99) with mean follow-up of 27.7 ± 26.9 months.
In complex AWR, preservation of the deep epigastric perforating vessels during ACS significantly lowers the rates of wound complications, despite its performance in more complex patients with an increased risk of infection. PS-ACS should be performed preferentially over a standard ACS whenever possible.
前侧组件分离（ACS）是一种成熟的、高度功能性的技术，可实现复杂腹壁重建（AWR）中的筋膜闭合。不幸的是，ACS 也与增加的伤口并发症风险相关。最近，为了维持源自深部腹壁血管的皮下穿支，出现了保留皮瓣穿支的 ACS（PS-ACS）技术。本研究旨在评估实施 PS-ACS 技术后接受开放式 AWR 患者的与伤口相关的结局。
前瞻性收集数据库，检索 2006 年至 2018 年间接受开放式 AWR 和 ACS 的患者。使用标准统计学方法比较接受 PS-ACS 与 ACS 的患者。接受合并式腹直肌皮瓣切除术的患者纳入 ACS 标准组。
共 252 例患者接受 ACS，其中 24 例（9.5%）接受 PS-ACS。除 PS-ACS 组吸烟比例较高（45.8%比 19.6%，p=0.003）外，两组患者的年龄和特定合并症相似（均 p>0.05）。平均疝缺损面积为 381.6±267.0cm2，复发疝占 64.3%，两组间相似（均 p>0.05）。PS-ACS 组的伤口更复杂，更多为腹壁疝分级 3 和 4 级（p=0.04）。手术时间和住院时间在两组间相似（均 p>0.05）。尽管复杂性增加，但 PS-ACS 组的伤口并发症发生率要低得多（20.8%比 46.1%，p=0.02），且所有特定的伤口并发症发生率较低，但无统计学差异。PS-ACS 组和 ACS 组的疝复发率相似（4.2%比 7.0%，p>0.99），平均随访时间为 27.7±26.9 个月。
在复杂的 AWR 中，ACS 过程中保留深部腹壁穿支血管可显著降低伤口并发症发生率，尽管其在感染风险较高的更复杂患者中表现更差。只要可能，应优先选择 PS-ACS 而不是标准 ACS。
Zotero 插件