Disa J J, Klein M H, Goldberg N H
Division of Plastic and Reconstructive Surgery, University of Maryland Medical System, USA.
Plast Reconstr Surg. 1996 Apr;97(4):801-6. doi: 10.1097/00006534-199604000-00017.
Although prosthetic patches (i.e., expanded polytetrafluoroethylene) are commonly used to repair abdominal fascial defects, autologous tissue is preferred in the presence of wound contamination. This study was undertaken to discover (1) whether fascial grafts are revascularized and incorporated as living tissue, and (2) whether fascial grafts are more resistant to bacterial contamination than prosthetic patches. In the first experiment, 18 New Zealand White rabbits underwent full-thickness resection of the central abdominal wall preserving only panniculus carnosus and skin. Six control animals had only skin repaired, and all developed large ventral hernias. Twelve animals had the defect repaired with thoracodorsal fascia patches. At 3- and 6-week intervals, no hernias were present and all patches were incorporated with minimal contraction. Fluorescein angiography verified revascularization from the surrounding abdominal wall. Next, 36 rabbits underwent similar resection followed by repair with either autologous fascia (n=18) or expanded polytetrafluoroethylene (n=17). Six rabbits of each repair group were inoculated with 10(4) Staphylococcus aureus and twelve rabbits with each repair were inoculated with 10(9) S. aureus. All rabbits receiving 10(4) S. aureus were infection-free survivors. Seven of the twelve expanded polytetrafluoroethylene-repaired animals receiving 10(9) S. aureus developed necrotizing wound infections and died. Only 2 of 12 rabbits with autologous fascia repairs died from wound sepsis and 1 died of diarrhea with a healed wound. Differences in wound infection rates achieved statistical significance, whereas survival differences approached significance (Fisher's exact test), suggesting that revascularized fascial grafts may be more resistant to bacterial contamination than expanded polytetrafluoroethylene patches at this concentration (10(9) S. aureus).
尽管人工补片（如膨化聚四氟乙烯）常用于修复腹部筋膜缺损，但在伤口污染的情况下，自体组织更为可取。本研究旨在探讨：（1）筋膜移植物是否会重新血管化并作为活组织整合；（2）筋膜移植物是否比人工补片更能抵抗细菌污染。在第一个实验中，18只新西兰白兔接受了腹壁全层切除术，仅保留了腹直肌前鞘和皮肤。6只对照动物仅修复皮肤，均出现了巨大的腹侧疝。12只动物用胸背筋膜补片修复缺损。在3周和6周时，均未出现疝，所有补片均已整合，收缩最小。荧光素血管造影证实了来自周围腹壁的重新血管化。接下来，36只兔子接受了类似的切除术，然后分别用自体筋膜（n = 18）或膨化聚四氟乙烯（n = 17）进行修复。每个修复组的6只兔子接种10⁴金黄色葡萄球菌，每个修复组的12只兔子接种10⁹金黄色葡萄球菌。所有接受10⁴金黄色葡萄球菌的兔子均无感染存活。接受10⁹金黄色葡萄球菌的12只接受膨化聚四氟乙烯修复的动物中有7只发生了坏死性伤口感染并死亡。12只接受自体筋膜修复的兔子中只有2只因伤口败血症死亡，1只因腹泻死亡，伤口已愈合。伤口感染率的差异具有统计学意义，而存活率差异接近显著水平（Fisher精确检验），表明在该浓度（10⁹金黄色葡萄球菌）下，重新血管化的筋膜移植物可能比膨化聚四氟乙烯补片更能抵抗细菌污染。
