Department of Surgery, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA.
Department of Surgery, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
BMJ Case Rep. 2021 Aug 17;14(8):e244219. doi: 10.1136/bcr-2021-244219.
We present the case of a 23-year-old man who developed abdominal compartment syndrome secondary to severe pancreatitis and required decompressive laparotomy and pancreatic necrosectomy. Despite application of a temporary abdominal closure system (ABThera Open Abdomen Negative Pressure Therapy), extensive retroperitoneal oedema and inflammation continued to contribute to loss of domain and prevented primary closure of the skin and fascia. The usual course of action would have involved reapplication of ABThera system until primary closure could be achieved or sufficient granulation tissue permitted split-thickness skin grafting. Though a safe option for abdominal closure, application of a skin graft would delay return to baseline functional status and require eventual graft excision with abdominal wall reconstruction for this active labourer. Thus, we achieved primary closure of the skin through the novel application of abdominal wall 'pie-crusting', or tension-releasing multiple skin incisions, technique.
我们报告了 1 例 23 岁男性患者，他因重症胰腺炎继发腹腔间隔室综合征而行减压剖腹术和胰腺坏死组织清除术。尽管应用了临时腹部闭合系统（ABThera 开放式腹部负压治疗），但广泛的腹膜后水肿和炎症持续导致缺损无法关闭，无法对皮肤和筋膜进行一期缝合。通常的做法是再次应用 ABThera 系统，直到可以实现一期缝合，或者有足够的肉芽组织允许进行中厚皮片植皮。虽然皮肤移植是一种安全的腹部闭合方法，但它会延迟患者恢复到基线功能状态，对于这位从事体力劳动的患者，最终需要切除移植物并进行腹壁重建。因此，我们通过新颖的腹壁“饼皮”或张力释放式多切口技术实现了皮肤的一期闭合。
