Management of the open abdomen with the Abdominal Reapproximation Anchor dynamic fascial closure system
Management of the open abdomen with the Abdominal Reapproximation Anchor dynamic fascial closure system
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DOI：
10.1016/j.amjsurg.2013.01.028
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发表时间：
2013-05-01
影响因子：
3
通讯作者：
Blair, N. Peter
中科院分区：
文献类型：
--
作者：
Haddock, Candace;Konkin, David E.;Blair, N. Peter
背景：随着损伤控制手术和开放性筋膜切开术的使用增加，一期筋膜闭合面临越来越大的挑战。本研究的目的是回顾性分析我们使用腹部再对合锚（ABRA; Canica Design Inc，阿尔蒙特，安大略，加拿大）的经验，这是一种动态筋膜闭合系统，用于在复杂腹部手术患者中获得筋膜贴壁。方法：对接受ABRA器械置入以辅助腹部闭合的患者进行回顾性分析。详细资料包括年龄，性别，开腹的原因，手术次数，一期缝合的时间，一期缝合的成功率，以及与使用ABRA相关的并发症进行了分析。平均急性生理学和慢性健康评估II评分为21.9 +/- 6.9。每例患者在ABRA置入前平均进行3.1 +/- 1.8次剖腹手术，ABRA置入至取出的持续时间为10.4 +/- 6.1天。在整个研究中，83%的患者实现了完全筋膜贴壁，在最后2年中，91%的患者实现了完全筋膜贴壁。在17%的病例中使用了成分分离。切口疝率在6个月时为13%，在12个月时为11%。结论：我们使用ABRA系统导致83%的筋膜贴壁率，当考虑到经验时进一步提高。在这一复杂患者组中，切口疝发生率可接受。这项技术是一个很好的补充，外科医生的医疗设备，复杂的腹部案件，需要一个开放的腹部。计划进行进一步的前瞻性研究，以确定该技术的理想候选人。皇冠版权所有（C）2013由Elsevier Inc.发布。All rights reserved.
BACKGROUND: With the increased use of damage control surgery and open abdomens, there are growing challenges in achieving primary fascial closure. The purpose of this study was to retrospectively review our experience using the Abdominal Reapproximation Anchor (ABRA; Canica Design Inc, Almonte, Ontario, Canada), a dynamic fascial closure system, to gain fascial apposition in complex abdominal surgical patients.METHODS: A retrospective review of patients who underwent placement of the ABRA device to aid in abdominal closure was undertaken. Details including age, sex, the reason for an open abdomen, the number of operations, the time to primary closure, the success rate of primary closure, and complications related to the use of the ABRA were analyzed.RESULTS: Between January 2006 and July 2011, 36 patient charts were identified. The average Acute Physiology and Chronic Health Evaluation II score was 21.9 +/- 6.9. There was a mean of 3.1 +/- 1.8 laparotomies before ABRA placement for each patient, and the duration of ABRA placement until removal was 10.4 +/- 6.1 days. Complete fascial apposition was achieved in 83% of the patients across the entire study and in 91% of the patients in the final 2 years. Component separation was used in 17% of cases. The incisional hernia rate was 13% at 6 months and 11% at 12 months.CONCLUSIONS: Our use of the ABRA system resulted in an 83% fascial apposition rate, which further improved when experience was taken into account. The incisional hernia rate was acceptable in this complicated patient group. This technique is an excellent addition to a surgeon's armamentarium for complicated abdominal cases that require an open abdomen. Further prospective studies are planned to identify ideal candidates for this technique. Crown Copyright (C) 2013 Published by Elsevier Inc. All rights reserved.