负压封闭引流联合异种脱细胞真皮基质临时覆盖后延期植皮修复严重感染的腹壁缺损(附7例报告)  

Postponed skin grafting for repairing abdominal wall defects with serious infections after vacuum sealing drainage plus temporary covering of acellular dermal matrix:a report of seven cases

作　　者：黄波 薛刚 张彦标 黄茜 李先慧 Huang Bo;Xue Gang;Zhang Yanbiao;Huang Xi;Li Xianhui(Department of Burns&Plastic Surgery,General Hospital,Western Theater Command,Sichuan Chengdu 610083,China)

机构地区：[1]西部战区总医院烧伤整形科,四川成都610083

出　　处：《腹部外科》2023年第1期55-59,共5页Journal of Abdominal Surgery

摘　　要：目的探讨严重的腹部外伤后继发腹壁缺损及感染的修复策略和方式。方法回顾性分析2018年1月至2020年6月西部战区总医院烧伤整形科收治的7例腹壁巨大缺损伴严重创面感染及腹腔或盆腔脏器外露病人的临床资料。采用异种脱细胞真皮基质(acellular dermal matrix,ADM))临时封闭腹腔后外用负压封闭引流(vacuum sealing drainage,VSD)技术持续冲洗及引流;待感染控制及肉芽组织生长良好后,拆除临时覆盖的异种ADM;选择刃厚皮片移植修复腹壁缺损后外用VSD敷料进行固定、引流,以保证皮片存活。结果7例病人经过2~4次清创及VSD治疗后,腹壁感染均得到有效的控制,创基肉芽组织生长良好。拆除临时覆盖的异种ADM后见其深面外露脏器均有网膜组织及肉芽组织覆盖,所有创面移植的自体刃厚皮片均一期成活,完全封闭创面。7例病人最长随访14个月,尚未出现需要外科干预、修复的严重腹壁疝。结论对于严重的腹壁缺损伴感染病人,尽早地控制感染及封闭创面是挽救病人生命、防治严重并发症的主要措施;利用异种ADM联合VSD能够有效地控制感染并保护腹腔脏器,从而能够尽早通过皮片移植修复创面,是救治该类病人的一种有效手段。Objective To explore the strategies and approaches of repairing abdominal wall defects and infections secondary to severe abdominal trauma.Methods From January 2018 to June 2020,clinical data were retrospectively reviewed for 7 patients with huge abdominal wall defect with severe wound infection and exposure of abdominal or pelvic organs.Heterogeneous acellular dermal matrix(ADM)was applied for temporarily sealing abdominal cavity and vacuum sealing drainage(VSD)for continuous irrigation and negative pressure drainage.After infection was controlled,granulation tissue grew well and heterogeneous ADM was removed.Blade-thickness skin was selected for repairing defects and VSD was fixed and drained to ensure dermal survival.Results Infection was effectively controlled and granulation tissue on wound surface grew well after 2 to 4 times of debridement and VSD drainage.After removing temporarily covered xenogeneic ADM,deep exposed organs were covered with omentum tissue and granulation tissue,reaching the conditions for skin grafting repair.Autologous blade-thickness skin graft survived.During a follow-up period of 14 months,no severe abdominal wall hernias required re-operation.Conclusion For severe abdominal wall defects and infections,early infection control and wound closure are the major measures of saving patient life and preventing serious complications.Combining heterogeneous ADM and continuous VSD can effectively control infection and protect internal organs.Thereby wound may be repaired by skin grafting as soon as possible.

关 键 词：腹壁缺损 负压封闭引流 异种脱细胞真皮基质 植皮修复 

分 类 号：R656.32[医药卫生—外科学]