Abdominal Wall Defect Primary Repairs Using Biologic Mesh In Infection Condition :3 Cases Report

BackgroundThe processing of abdominal wall defect in infection or contamination condition is a big problem of abdominal surgery.The first principle of management is debridement and adequate drainage,then stage I or stage II suture according to the actual circumstances of the wound.Along with the advance of surgical materials and technology, the increasing requirement of the patient, stage I repair after debridement become a big challenge.Most scholars don’t recommend to repair abdominal wall defect in infection or contamination condition by using polymer materials,the effect is poorer because once the patch infection occurs especially in late infection, often need to take out the patch.Since the first reports of clinical Edelman to use SIS biological patch repair of inguinal hernia,Biological patch for the treatment of abdominal wall hernia and abdominal wall defects has more than 10 years in foreign countries.In recent years,the domestic understanding of biological patch is rising and biological patch becomes a new research hotspot in the field of abdominal surgery.Biological patch can be understood as "cell scaffolds",it according to the principle of molecular biology, regenerative medicine and immunology principle.After implantation in the human body,it can have very good support effect, fill the lack of the damaged parts of the organization. In the material induced, the body can grow a new organization by own repair function in the original position gradually to replace biological materials. The process of organ tissue regeneration completed. The biological patch has a wide rang of clinical application. In the past, it can be applied in lung cancer, tumor, abdominal wall hernia, repairing the skull, gynecology, urogenital, neurosurgery, dura repair, repairing after esophageal cancer resection, pleural and bone repair after the separation of conjoined twins, and rescuing of large area burn patients, and used in the field of cosmetic surgery. With the understanding of the anti-infection characteristics of biological patch, more and more clinical physicians use it for repairing infectious abdominal wall defect, and achieved good results.Combining with three cases of infectiou abdominal wall defects by using biological patch in our hospital,discussing the basic principle、advantages and prospect of biological patch, we conclude some experience and provide clinical basis for the patch of infectious abdominal wall defects. Objective 1.To observe the biological patch application effect in the infection state of abdominal wall defect. 2.To explore the clinical application value of biological patch. MethodsBy retrospective analysis the clinical data of applying pig small intestinal submucosa(SIS) in three patients of abdominal wall defect caused by incision infection,in July 2012- January 2015,in the first affiliated hospital of dalian medical university。Combining with the experience to handle such patients at home and abroad, this paper discusses the application prospect of biological patches, and summarize our experience. ResultsAll three patients were recovered after the operation,except one case delayed union due to incision fat liquefaction, healing of incision of the remaining two cases were serie A.Two patients were placed drainage tube, wich took out in 14 d and 10 d postoperative,then hospital discharge in 16 d and 14 d postoperative.One patient appears abdominal wall bulging after six months after surgery repair,and without any further treatment because of recurrence of gastric cancer accompanied multiple metastases followed up for two years.One patient restores good followed up for six months, with no incision hernia, pain and other complications.One outpatient repair in local anesthesia,follow-up treatment, follow-up two months healed well, no incision hernia.Conclusions1.Biological patch provides a good choice for patients with infectious abdominal wall defect;2.For the defect of abdominal wall with muscle fascia cant’t be sutured,long-term follow-up result of biological patch tensile strength isn’t satisfactory;3.Component separation technique may be a good method to solve the problem that biological patch tensile strength is not enough.