Alkemade E A J, Baranski A G
Leiden University Medical Center, Leiden, the Netherlands.
Abdominal Organ Transplant Centre, Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
Int J Surg Case Rep. 2025 Mar;128:111029. doi: 10.1016/j.ijscr.2025.111029. Epub 2025 Feb 7.
Large incisional hernias in high-risk patients, such as those undergoing immunosuppressive therapy, represent an extra surgical challenge due to elevated risks of infection and poor wound healing. This case report details the reconstruction of an abdominal wall defect in a high-risk patient using a high-cost yet robust and effective biologic mesh.
A 38-year-old obese female with multiple comorbidities developed an LIH and an incarcerated left-sided inguinal hernia following a kidney transplantation. The surgical approach involved a two-layer mesh reconstruction, combining a biologic intraperitoneal mesh and an absorbable onlay mesh. To reduce the risk of infection and provide extra reinforcement, the hernia sac was preserved and sutured over the biologic mesh. Postoperative complications, including infection and seroma formation, were managed effectively with negative pressure wound therapy. The wound closed after seven months, with no recurrence observed during follow-up.
The biologic mesh, combined with the well-vascularized sac, demonstrated integration with vascularized tissue, minimizing infection risk, and providing natural reinforcement and enhanced healing. Advanced wound management, including negative pressure wound therapy, effectively resolved postoperative complications such as infection and seroma.
This case demonstrates the use of a multilayer reconstruction approach that combines a biologic mesh and the reuse of the hernia sac, offering a viable option for managing complex hernias in high-risk, immunosuppressed patients. This technique minimizes infection risk and provides stable long-term outcomes, even in challenging clinical settings.
高危患者，如接受免疫抑制治疗的患者，出现的大型切口疝由于感染风险升高和伤口愈合不良，给手术带来了额外挑战。本病例报告详细介绍了使用一种高成本但坚固有效的生物补片对一名高危患者的腹壁缺损进行修复的情况。
一名38岁患有多种合并症的肥胖女性在肾移植后出现了大型切口疝和左侧嵌顿性腹股沟疝。手术方法包括两层补片修复，将生物性腹膜内补片和可吸收覆盖补片相结合。为降低感染风险并提供额外加固，保留疝囊并缝合在生物补片上。术后并发症，包括感染和血清肿形成，通过负压伤口治疗得到有效处理。伤口在七个月后愈合，随访期间未观察到复发。
生物补片与血运丰富的疝囊相结合，显示出与血管化组织的整合，将感染风险降至最低，并提供自然加固和促进愈合。先进的伤口管理，包括负压伤口治疗，有效解决了术后并发症，如感染和血清肿。
本病例展示了一种多层修复方法的应用，该方法结合了生物补片和疝囊的再利用，为管理高危、免疫抑制患者的复杂疝提供了一种可行的选择。即使在具有挑战性的临床环境中，该技术也能将感染风险降至最低，并提供稳定的长期效果。
