Rezende-Neto Joao Baptista, Camilotti Bruna Gewehr
Surgery, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.
General Surgery, St Michael's Hospital, Toronto, Ontario, Canada.
Trauma Surg Acute Care Open. 2020 Nov 11;5(1):e000523. doi: 10.1136/tsaco-2020-000523. eCollection 2020.
Primary closure of the fascia at the conclusion of a stage laparotomy can be a challenging task. Current techniques to medialize the fascial edges in open abdomens entail several trips to the operating room and could result in fascial damage. We conducted a pilot study to investigate a novel non-invasive device for gradual reapproximation of the abdominal wall fascia in the open abdomen.
Mechanically ventilated patients ≥16 years of age with the abdominal fascia deliberately left open after a midline laparotomy for trauma and acute care surgery were randomized into two groups. Control group patients underwent standard care with negative pressure therapy only. Device group patients were treated with negative pressure therapy in conjunction with the new device for fascial reapproximation. Exclusion criteria: pregnancy, traumatic hernias, pre-existing ventral hernias, burns, and body mass index ≥40 kg/m. The primary outcome was successful fascial closure by direct suture of the fascia without mesh or component separation. Secondary outcomes were abdominal wall complications.
Thirty-eight patients were investigated, 20 in the device group and 18 in the control group. Primary closure of the fascia by direct suture without mesh or component separation was achieved in 17 patients (85%) in the device group and only 10 patients (55.6%) in the control group (p=0.0457). Device group patients were 53% more likely to experience primary fascial closure by direct suture than control group patients. Device group showed gradual reduction (p<0.005) in the size of the fascial defects; not seen in control group. There were no complications related to the device.
The new device applied externally on the abdominal wall promoted reapproximation of the fascia in the midline, preserved the integrity of the fascia, and improved primary fascial closure rate compared with negative pressure therapy system only.
I, randomized controlled trial.
在分期剖腹手术结束时对筋膜进行一期缝合可能是一项具有挑战性的任务。目前在开放腹部将筋膜边缘向内侧拉拢的技术需要多次进入手术室，并且可能导致筋膜损伤。我们进行了一项前瞻性研究，以调查一种用于在开放腹部逐渐使腹壁筋膜重新对合的新型非侵入性装置。
年龄≥16岁、因创伤和急性护理手术行中线剖腹手术后故意敞开腹部筋膜的机械通气患者被随机分为两组。对照组患者仅接受标准的负压治疗。装置组患者接受负压治疗并结合用于筋膜重新对合的新装置。排除标准：妊娠、创伤性疝、既往存在的腹侧疝、烧伤以及体重指数≥40kg/m²。主要结局是通过直接缝合筋膜且不使用补片或进行组织分离成功实现筋膜闭合。次要结局是腹壁并发症。
共研究了38例患者，装置组20例，对照组18例。装置组17例患者（85%）通过直接缝合且不使用补片或进行组织分离实现了筋膜一期闭合，而对照组仅10例患者（55.6%）实现了这一目标（p = 0.0457）。装置组患者通过直接缝合实现一期筋膜闭合的可能性比对照组患者高53%。装置组的筋膜缺损大小逐渐减小（p < 0.005）；对照组未观察到这种情况。未出现与该装置相关的并发症。
与仅使用负压治疗系统相比，外部应用于腹壁的新装置促进了中线筋膜的重新对合，保留了筋膜的完整性，并提高了一期筋膜闭合率。
I，随机对照试验。
