Clinical value of human acellular dermal matrix in reconstruction of giant complex abdominal wall defects after open abdomen

Abstract

Objective To explore the clinical value of human acellular dermal matrix (HADM) in giant complex abdominal wall reconstruction (GCAWR) after open abdomen. Methods The retrospective cross-sectional study was conducted. The clinical data of 6 patients with severe trauma who were admitted to the Nanjing General Hospital of Nanjing Military Command of Nanjing University School of Medicine between January 2013 and January 2014 were collected. After open abdomen, fascia of the abdominal wall was fully freed using the component separation, and abdominal wall defects were reconstructed using HADM in the rectus abdominis anterior sheath and peritoneal layers bridge-type suture. Observation indicators: (1) intra- and post-operative situations: operation time, volume of intraoperative blood loss, removal time of postoperative drainage-tube, postoperative com-plications, duration of hospital stay and hospital expenses; (2) follow-up situations: recurrence of abdominal wall hernia at postoperative year 2. Follow-up using outpatient examination and telephone interview was performed to detect the recurrence of abdominal wall hernia up to April 2016. Measurement data with normal distribution were represented as ±s. Results (1) Intra- and post-operative situations: 6 patients underwent successful surgery. Operation time, volume of intraoperative blood loss and removal time of postoperative drainage-tube were respectively (77±9)minutes, (225±57)mL and (8±3)days. Two patients with postoperative seroma were cured by conservative treatment. One patient with postoperative anastomotic leakage received continuously irrigation and drainage, and leakage was stopped using the biomedical fibrin glue. There was no abdominal bulge of the 6 patients in hospital. Duration of hospital stay and hospital expenses were respectively (10±3)days and (12±7)×104 yuan. (2) Followup situations: 6 patients were followed up for 14-28 months, with a median time of 23 months. Two patients had relaxation and bulge of HADM in peritoneal layer at postoperative 2 years, without bulge of HADM in the rectus abdominis anterior sheath layer. There were no occurrence of abdominal wall hernia, chronic pain, paraesthesia, swelling in the local area and other adverse reaction. Conclusion Using of HADM in the rectus abdominis anterior sheath and peritoneal layers bridgetype suture is safe and feasible for GCAWR, with good short-term outcomes. Key words: Complex abdominal wall defect; Open abdomen; Human acellular dermal matrix