Department of Surgery, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse 12, 91054, Erlangen, Germany.
Department of Plastic Surgery, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse 12, 91054, Erlangen, Germany.
World J Surg. 2021 Jan;45(1):132-140. doi: 10.1007/s00268-020-05788-5. Epub 2020 Sep 29.
Management of donor site closure after harvesting a vertical rectus abdominis myocutaneous (VRAM) flap is discussed heterogeneously in the literature. We aim to analyze the postoperative complications of the donor site depending on the closure technique.
During a 12-year period (2003-2015), 192 patients in our department received transpelvic VRAM flap reconstruction. Prospectively collected data were analyzed retrospectively.
182 patients received a VRAM flap reconstruction for malignant, 10 patients for benign disease. The median age of patients was 62 years. 117 patients (61%) received a reconstruction of donor site by Vypro® mesh, 46 patients (24%) by Vicryl® mesh, 23 patients (12%) by direct closure and 6 patients (3%) by combination of different meshes. 32 patients (17%) developed in total 34 postoperative complications at the donor site. 22 complications (11%) were treated conservatively, 12 (6%) surgically. 17 patients (9%) developed incisional hernia during follow-up, with highest incidence in the Vicryl® group (n = 8; 17%) and lowest in the Vypro® group (n = 7; 6%). Postoperative parastomal hernias were found in 30 patients (16%) including three patients with simultaneous hernia around an urostomy and a colostomy. The highest incidence of parastomal hernia was found in patients receiving primary closure of the donor site (n = 6; 26%), the lowest incidence in the Vypro® group (n = 16; 14%).
The use of Vypro® mesh for donor site closure appears to be associated with a low postoperative incidence of complications and can therefore be recommended as a preferred technique.
在文献中，对于垂直腹直肌肌皮瓣（VRAM）皮瓣采集后供区的关闭处理存在不同的意见。我们旨在分析不同关闭技术的供区术后并发症。
在 12 年期间（2003-2015 年），我们科室的 192 位患者接受了经盆腔 VRAM 皮瓣重建。前瞻性收集的数据进行回顾性分析。
182 位患者因恶性疾病接受 VRAM 皮瓣重建，10 位患者因良性疾病接受重建。患者的中位年龄为 62 岁。117 位患者（61%）接受 Vypro®网片进行供区重建，46 位患者（24%）接受 Vicryl®网片，23 位患者（12%）直接关闭，6 位患者（3%）使用不同网片的联合方法。32 位患者（17%）的供区总共发生了 34 例术后并发症。22 例（11%）接受了保守治疗，12 例（6%）接受了手术治疗。17 位患者（9%）在随访期间发生切口疝，其中 Vicryl®组发生率最高（n=8；17%），Vypro®组发生率最低（n=7；6%）。30 位患者（16%）发生术后吻合口旁疝，其中 3 位患者同时发生了造口旁疝和肠造口旁疝。接受供区直接关闭的患者吻合口旁疝发生率最高（n=6；26%），Vypro®组发生率最低（n=16；14%）。
Vypro®网片用于供区关闭似乎与术后并发症发生率低相关，因此可以作为首选技术推荐。
