Howdieshell T R, Yeh K A, Hawkins M L, Cué J I
Department of Surgery, Trauma/Surgical Critical Care, Medical College of Georgia, Augusta 30912, USA.
World J Surg. 1995 Jan-Feb;19(1):154-8; discussion 158. doi: 10.1007/BF00317004.
From 1988 to 1992 more than 5300 patients were admitted to a level I trauma center, with 36 of these patients requiring Silastic abdominal closure. Patients ages ranged from 13 to 75 years with a mean Injury Severity Score (ISS) of 30 (range 13-50). Nineteen patients (53%) suffered penetrating injuries, and 17 (47%) were victims of blunt trauma. Silastic closure was performed at admission laparotomy in 15 patients (42%) due to inability to close the fascia primarily. Twenty-one patients (58%) underwent Silastic closure at reexploration for inability to close primarily (12 patients), elevated intraabdominal pressure with deteriorating renal function (6 patients), and wound sepsis with fascial necrosis (3 patients). Twenty-six patients (72%) survived and 10 patients (28%) expired. The causes of death were multiple organ failure (9 patients) and exsanguination (1 patient). Of the 26 survivors, 8 patients (31%) underwent fascial closure at initial hospitalization, and 18 patients (69%) required split-thickness skin grafting to visceral granulation tissue. Of these 18 patients, 13 (72%) have already undergone ventral herniorrhaphy at subsequent admission. No patient developed a complication attributable to the technique.
1988年至1992年期间，超过5300名患者被收治于一家一级创伤中心，其中36名患者需要使用硅橡胶进行腹壁闭合。患者年龄在13岁至75岁之间，平均损伤严重程度评分（ISS）为30分（范围为13 - 50分）。19名患者（53%）为穿透伤，17名患者（47%）为钝性创伤。15名患者（42%）因无法一期关闭筋膜，在入院剖腹手术时进行了硅橡胶闭合。21名患者（58%）因无法一期关闭（12名患者）、腹腔内压力升高伴肾功能恶化（6名患者）以及伤口脓毒症伴筋膜坏死（3名患者），在再次探查时进行了硅橡胶闭合。26名患者（72%）存活，10名患者（28%）死亡。死亡原因是多器官功能衰竭（9名患者）和失血（1名患者）。在26名幸存者中，8名患者（31%）在初次住院时进行了筋膜闭合，18名患者（69%）需要对内脏肉芽组织进行中厚皮片移植。在这18名患者中，13名患者（72%）在随后的入院治疗中已经接受了腹疝修补术。没有患者出现与该技术相关的并发症。
