DiBello J N, Moore J H
Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Plast Reconstr Surg. 1996 Sep;98(3):464-9. doi: 10.1097/00006534-199609000-00016.
Despite a reported incidence of up to 11 percent of incisional/ventral hernias following celiotomies, there is no universally applicable preventive or reconstructive technique in practice. Among patients undergoing repair of ventral incisional herniation, the reported recurrence rates are typically in the 30- to 50-percent range. This study concentrates on the patient with a large, recurrent abdominal incisional hernia in whom conventional surgical repair has failed. We report our recent 4-year experience with the use of "components separation" of the myofascial layers of the abdominal wall for repair of these recurrent herniations. During 4-year period, 35 patients with large, recurrent ventral hernias underwent repair by the same surgeon (J. H. M.) using the method described below. Abdominal defects as large as 875 cm2 were repaired, with a median defect size of 255 cm2. The repair was based on the compound flap of the rectus muscle with its attached internal oblique-transversus abdominus muscle with advancement to the midline to recreate the linea alba. Any repairs that were attenuated were supported with either ePTFE (8.6 percent) or Vicryl mesh (34 percent). The study group consisted of 35 patients, 34 percent male and 66 percent female; mean age was 55 years. Length of follow-up ranged from 1 to 43 months, with a mean follow-up of 22 months. Overall recurrence rate for herniation was 8.5 percent (3/35). Additional complications, namely seroma, wound infection, and hematoma, occurred at rates of 2.8, 5.7, and 5.7 percent, respectively. There were no mortalities. The compound flap of the rectus and internal oblique-transversus can be advanced medially to recreate the linea alba to provide dynamic, stable support for defects as large as 875 cm2. A recurrence rate of 8.5 percent was achieved in a relatively high-risk population with acceptable morbidity and no mortalities. In our 4-year experience, the sliding rectus abdominus myofascial flap has proved to be a safe and effective tool for dealing with patients in whom conventional means of repair have failed.
尽管据报道剖腹术后切口/腹侧疝的发生率高达11%，但实际上并没有普遍适用的预防或重建技术。在接受腹侧切口疝修补术的患者中，报道的复发率通常在30%至50%之间。本研究聚焦于传统手术修复失败的大型复发性腹部切口疝患者。我们报告了我们最近4年使用腹壁肌筋膜层“成分分离”法修复这些复发性疝的经验。在4年期间，35例大型复发性腹侧疝患者由同一位外科医生（J.H.M.）使用下述方法进行修复。修复的腹部缺损面积大至875平方厘米，缺损大小中位数为255平方厘米。修复基于带有附着的腹内斜肌-腹横肌的腹直肌复合瓣，将其推进至中线以重建白线。任何薄弱的修复均使用ePTFE（8.6%）或薇乔网片（34%）进行支撑。研究组由35例患者组成，男性占34%，女性占66%；平均年龄为55岁。随访时间为1至43个月，平均随访22个月。疝的总体复发率为8.5%（3/35）。其他并发症，即血清肿、伤口感染和血肿的发生率分别为2.8%、5.7%和5.7%。无死亡病例。腹直肌和腹内斜肌-腹横肌复合瓣可向内侧推进以重建白线，为大至875平方厘米的缺损提供动态、稳定的支撑。在相对高危的人群中实现了8.5%的复发率，且发病率可接受，无死亡病例。根据我们4年的经验，滑动腹直肌肌筋膜瓣已被证明是处理传统修复方法失败患者的一种安全有效的工具。
