Restoring Abdominal Wall Integrity in Contaminated Tissue‐Deficient Wounds Using Autologous Fascia Grafts
Restoring Abdominal Wall Integrity in Contaminated Tissue‐Deficient Wounds Using Autologous Fascia Grafts
复制标题
使用自体筋膜移植物恢复污染的组织缺陷伤口的腹壁完整性
DOI：
10.1097/01.prs.0000101539.77505.e6
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发表时间：
1998
影响因子：
3.6
通讯作者：
Sheri S. Slezak
中科院分区：
文献类型：
--
作者：
J. Disa;N. Goldberg;James M. Carlton;B. Robertson;Sheri S. Slezak
患者;腹壁坏死性感染、肠瘘或腹疝修复后暴露的假体材料通常会导致腹壁完整性的丧失。由于高感染率，需要移除假体并进一步进行腹壁清创，因此通常禁止在污染伤口进行手术重建。因此，在过去的9年里，我们一直使用自体阔筋膜的游离移植物来替代缺乏的腹壁筋膜和肌肉，在假体材料是禁忌的情况下，局部组织重排（即成分分离）是不够的。32例患者（平均年龄59岁）采用自体阔筋膜移植进行腹壁重建。适应症包括外露补片（31%）、肠瘘（28%）、肠道污染（22%）、伤口感染（13%）和单独免疫抑制（6%）；31%的患者继发于实体器官移植或全身性炎症性疾病的免疫抑制。将筋膜移植物（平均尺寸10 × 17 cm）缝合于周围腹壁，局部皮瓣推进和/或肌皮瓣旋转覆盖。所有腹部重建最初都是成功的。随后的局部腹壁并发症包括蜂窝织炎（n = 3）、血清肿（n = 2）和皮肤开裂伴显露的筋膜移植物（n = 7）。7例皮肤开裂患者中有5例继发性愈合，而2例裂厚皮肤移植成功地应用于肉芽筋膜。大腿供区并发症包括血肿（n = 1）、皮肤开裂（n = 1）、血清肿（n = 2）。没有一例侧膝不稳。平均随访期为27个月（3 ~ 106个月）。3例（9%）患者出现复发性疝。有趣的是，有三名患者因不相关的腹内疾病通过完整的阔筋膜补片进行剖腹手术。在每个病例中，移植物都是完整的和血运重建的，证实了我们实验室的实验动物数据。剖腹探查未发现复发疝。我们9年的经验表明，面对大面积的、受污染的腹部伤口，在这些伤口中，假体材料是禁忌的，局部组织重排是不够的，自体宽筋膜移植是腹壁重建的可靠辅助。
&NA; Necrotizing abdominal wall infections, enteric fistulae, or exposed prosthetic material after ventral hernia repair often results in a loss of abdominal wall integrity. Further surgical reconstruction with prosthetic material is usually contraindicated in the contaminated wound because of the high infection rate necessitating prosthetic removal and further abdominal wall debridement. Consequently, for the past 9 years, we have been using free grafts of autologous fascia lata to replace deficient abdominal wall fascia and muscle in situations where prosthetic material is contraindicated and local tissue rearrangement (i.e., component separation) would be inadequate. Thirty‐two patients (mean age 59 years) underwent abdominal wall reconstruction with autologous fascia lata grafts. Indications included exposed mesh (31 percent), enteric fistulae (28 percent), enteric contamination (22 percent), wound infection (13 percent), and immunosuppression alone (6 percent); 31 percent of all patients were immunosuppressed secondary to either a solid organ transplant or a systemic inflammatory disorder. Fascia grafts (mean size 10 × 17 cm) were sutured to the surrounding abdominal wall and covered by local skin flap advancement and/or myocutaneous flap rotation. All abdominal reconstructions were initially successful. Subsequent local abdominal wall complications included cellulitis (n = 3), seroma (n = 2), and skin dehiscence with exposed fascia grafts (n = 7). Five of seven patients with skin dehiscence healed by secondary intention, whereas two had split‐thickness skin grafts successfully applied to the granulating fascia. Thigh donor site complications included hematoma (n = 1), skin dehiscence (n = 1), and seroma (n = 2). There have been no cases of lateral knee instability. The average follow‐up period is 27 months (range 3 to 106 months). Recurrent hernia has been seen in three patients (9 percent). Interestingly, laparotomy has been performed through an intact fascia lata patch in three patients for unrelated intra‐abdominal conditions. In each case, the graft was intact and revascularized, confirming experimental animal data performed in our laboratory. Recurrent hernia has not been observed through the laparotomy site. Our 9‐year experience has demonstrated that in the face of large, contaminated abdominal wounds where prosthetic material is contraindicated and local tissue rearrangement would be inadequate, fascia lata autografts are a reliable adjuvant to abdominal wall reconstruction.