Peacock E E
Ann Surg. 1984 Sep;200(3):321-7. doi: 10.1097/00000658-198409000-00009.
Repeated recurrence of groin hernia is more than an anatomical derangement that any trained surgeon can correct. Attempts to improve results include application of local patches of Marlex. There are two reasons (one theoretical and one practical) why a local synthetic patch may not be as useful as total reconstruction of endopelvic fascia with a biologically active, as well as structurally strong, living material. Such a restoration can be accomplished with the entire fascia lata from one thigh utilized as a free graft extending from one pelvic wall to the other and from the symphysis to the pubic rami. The practical advantage of a single sheet of fascia extending across the pelvic floor (like an airplane wing) is that frequent medial recurrences are eliminated because there is no medial edge under which peritoneum can protrude. The theoretical advantage of a biologically active graft is based upon animal data revealing the inductive capacity of fascia in stimulating net collagen synthesis and deposition. Thirteen patients with multiple recurrences following conventional repair of groin hernia have been reconstructed with large fascia lata grafts restoring the entire endopelvic floor. Over a 5-year period no recurrences have been detected. A technique for removing the entire fascia lata from one thigh through a single transverse incision will be shown. There have not been any donor site complications and there is no disability caused by removing the fascia.
腹股沟疝的反复复发不仅仅是任何受过训练的外科医生都能纠正的解剖结构紊乱。为改善治疗效果所做的尝试包括应用Marlex局部补片。局部合成补片可能不如使用具有生物活性且结构坚固的活体材料对盆腔内筋膜进行全层重建有效的原因有两个（一个是理论原因，一个是实际原因）。这种重建可以通过取自一侧大腿的整块阔筋膜作为游离移植物来完成，该移植物从一侧骨盆壁延伸至另一侧，从耻骨联合延伸至耻骨支。一片阔筋膜横跨盆底（就像飞机机翼）的实际优势在于，由于没有可供腹膜突出的内侧边缘，从而消除了频繁的内侧复发。生物活性移植物的理论优势基于动物实验数据，该数据表明筋膜具有刺激净胶原蛋白合成和沉积的诱导能力。13例腹股沟疝传统修补术后多次复发的患者已接受了使用大块阔筋膜移植物重建整个盆腔内盆底的手术。在5年的时间里未检测到复发。本文将展示一种通过单一横向切口从一侧大腿取出整块阔筋膜的技术。未出现任何供区并发症，且取出阔筋膜也未导致功能障碍。
