Byrnes Yasmeen M, Othman Sammy, Elfanagely Omar, Card Elizabeth B, Mellia Joseph A, Llado-Farrulla Monica, Fischer John P
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa.
Plast Reconstr Surg Glob Open. 2020 Dec 16;8(12):e3308. doi: 10.1097/GOX.0000000000003308. eCollection 2020 Dec.
Incisional hernias, especially those below the arcuate line, pose a unique challenge to reconstructive surgeons, as no consensus exists for repair strategy. An innovative approach is presented and illustrated. The "corset repair" involves placing an onlay mesh partially beneath released bilateral external obliques. A detailed technical review is provided to illustrate the benefits of this technique particularly in large defects and in hernia after abdominal flap harvest. Hernia recurrence and surgical site occurrence rates were reviewed and analyzed for a cohort of corset repair patients between December 2016 and January 2020. Twenty patients were included. All defects were successfully closed. Zero patients experienced hernia recurrence. Eight patients (40%) had a surgical site occurrence, of which 5 (63%) were either observed or managed non-operatively. Two of the surgical site occurrences were deep surgical site infections: 1 required surgical intervention for suspected mesh infection and the other did not. One patient (5%) developed hematoma 23 months post-operatively. The "corset repair" technique represents a modification to a classic technique for hernia repair. It is feasible and may be advantageous especially for large or challenging repairs below the arcuate line. It has promising results on early follow-up, and further research is needed to evaluate long-term efficacy.
切口疝，尤其是弓状线以下的切口疝，给重建外科医生带来了独特的挑战，因为目前对于修复策略尚无共识。本文介绍并阐述了一种创新方法。“束腰修复术”包括将一块补片部分置于双侧游离的腹外斜肌下方。本文提供了详细的技术回顾，以说明该技术的益处，特别是在处理大的缺损以及腹部皮瓣切取术后的疝时。我们回顾并分析了2016年12月至2020年1月期间接受束腰修复术患者队列的疝复发率和手术部位发生率。纳入了20例患者。所有缺损均成功闭合。零例患者出现疝复发。8例患者（40%）发生了手术部位事件，其中5例（63%）通过观察或非手术方式处理。手术部位事件中有2例为深部手术部位感染：1例因怀疑补片感染需要手术干预，另1例则不需要。1例患者（5%）在术后23个月发生了血肿。“束腰修复术”是对经典疝修补技术的一种改良。它是可行的，尤其对于弓状线以下的大的或具有挑战性的修复可能具有优势。其早期随访结果良好，需要进一步研究以评估其长期疗效。
