Amro Chris, Ewing Jane N, Romeo Dominic J, Rhodes Isaiah J, Gala Zachary, Lemdani Mehdi S, McGraw J Reed, Broach Robyn B, Kovach Stephen J, Fischer John P
Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Hansjörg Wyss Department of Plastic Surgery, NYU Langone, New York, New York.
Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
J Surg Res. 2025 Jan;305:398-405. doi: 10.1016/j.jss.2024.10.044. Epub 2025 Jan 4.
Abdominal wall reconstruction (AWR) with ventral hernia repair (VHR) in the setting of contamination poses unique and controversial challenges. The purpose of this study was to examine the efficacy of onlay resorbable biosynthetic mesh against underlay biologic mesh in contaminated VHR with AWR.
A single-center retrospective review from 2015 to 2021 was performed examining subjects who underwent VHR with AWR in contaminated fields (Centers for Disease Control wound class II-IV). A matched paired analysis based on age, body mass index, and Centers for Disease Control wound class was conducted among patients who utilized resorbable biosynthetic mesh in an onlay fashion and biologic mesh in an underlay fashion.
A total of 94 patients (47 per group) underwent VHR with AWR in contaminated fields. Patients who utilized biosynthetic mesh had an average defect size of 314.56 ± 214.65 cm, required component separation (57.4%), and were often recurrent (61.7%). Majority of contamination were clean-contaminated (68.1%), followed by dirty/infected (19.1%), and contaminated (12.8%). Patients utilizing resorbable biosynthetic mesh experienced fewer surgical site occurrences (SSOs) (46.8% versus 72.3%, P < 0.05) and fewer SSO procedural interventions (19.1% versus 38.4%, P < 0.05). Patients with biosynthetic mesh had fewer hernia recurrences compared to biologic mesh use; however, was not statistically significant (14.9% versus 30.4%, P = 0.07), with a mean follow-up of 25.73 ± 18.66 mo.
Utilization of resorbable biosynthetic mesh may be preferable to biologic mesh in contaminated fields due to lower rates of SSOs and interventions, ultimately reducing the postoperative clinical and financial burden for this patient population.
在存在污染的情况下进行腹壁重建（AWR）及腹疝修补术（VHR）带来了独特且具有争议性的挑战。本研究的目的是比较在污染性VHR伴AWR中，采用补片植入可吸收生物合成补片与补片植入生物补片的疗效。
对2015年至2021年期间在污染区域（疾病控制中心伤口分类II-IV级）接受VHR伴AWR的患者进行单中心回顾性研究。对采用补片植入方式使用可吸收生物合成补片和采用补片植入方式使用生物补片的患者，基于年龄、体重指数和疾病控制中心伤口分类进行配对分析。
共有94例患者（每组47例）在污染区域接受了VHR伴AWR。使用生物合成补片的患者平均缺损大小为314.56±214.65平方厘米，需要进行组织分离（57.4%），且经常复发（61.7%）。大多数污染为清洁-污染（68.1%），其次是脏污/感染（19.1%）和污染（12.8%）。使用可吸收生物合成补片的患者手术部位感染（SSO）发生率较低（46.8%对72.3%，P<0.05），SSO相关的手术干预较少（19.1%对38.4%，P<0.05）。与使用生物补片相比，使用生物合成补片的患者疝复发较少；然而，差异无统计学意义（14.9%对30.4%，P=0.07），平均随访时间为25.73±18.66个月。
在污染区域使用可吸收生物合成补片可能优于生物补片，因为其SSO发生率和干预率较低，最终减轻了该患者群体的术后临床和经济负担。
