Retrospective Study Of 22 Cases Repairment Of Complete Abdominal Wound Dehiscence By Biological Mesh Combined With Negative Pressure Drainage

Background Abdominal wound dehiscence(AWD)after abdominal surgery is a serious postoperative complication.Being dependent on reports,its incidence is about1%-5%,and the mortality rate is 6.25%-25%.Among them,about 86.9%of patients require urgent surgery.The incidence of incisional hernia is about 13.1%.The usual surgical strategy for treating AWD is to close the abdomen directly with suture.It is simple and time-saving to close the abdomen directly,but it is plagued by the high incidence of recurrence and incisional hernia formation.Some doctors tried to implant a synthetic mesh,which significantly reduced the incidence of incisional hernias,but brought more surgical complications.Biological meshes have been widely used in the repair of various hernias and abdominal wall defects due to their good anti-infection performance and the ability to maintain satisfactory tension after implantation,and the repair effect is satisfactory.However,the use of biological meshes to repair complete abdominal wound dehiscence(CAWD)is limited to case reports,and systematic studies are lacking.We tried to use biological mesh to repair CAWD,providing a new idea for clinical work.Objective This study intended to explore the feasibility of using the extracellular matrix derived from porcine small intestinal submucosa(SIS)combined with negative pressure drainage in patients with CAWD after laparotomy.Methods Patients who underwent CAWD reinforcement with SIS mesh was performed from February 2015 to September 2019.Each SIS mesh was individually tailored to exceed the edge of the dehisced peritoneum by 3-5cm,and a negative pressure drainage tube was placed in front of the mesh to ensure that the SIS mesh and the peritoneum fit closely.We assessed the safety and effectiveness of this surgical approach by observing postoperative complications.Results A total of 22 patients(14 males,8 feamles)underwent CAWD repairment with SIS mesh implantation.Preoperative characteristics include median age of 64.0years(range:29.0-72.0 years),an mean body mass index of 21.2±1.5 kg/m~2,and the median length of the dehisced incision was 5.0 cm(interquartile range:4.0-10.0 cm).The median size of the mesh was 175.0 cm~2(interquartile range:150.0-220.0 cm~2).The mean time for abdominal wall closure was 102.3±17.2 min,and the mean hospitalization time was 20.3±7.2 d.All patients were discharged safely.Mean follow-up was 28.8±2.8months.All patients had firm fixation of the mesh after the operation,and there was no re-dehiscence,reoperation,intestinal fistula,rejection reaction,or incisional hernia and death.About 5(22.7%)patients developed seroma,which disappeared after symptomatic treatment.Chronic pain was observed in 3(13.6%)patients,none of their daily lives were influenced.Two(9.0%)patients expressed foreign body sensation,which disappeared at 6 months and 8 months respectively after surgery.Incision infection was found in 1(4.5%)patient,and the incision healed after dressing.Conclusion Implantation of an SIS mesh combined with negative pressure drainage to repair CAWD seems to be a safe and effective treatment method.At the same time,it is also necessary to assist with comprehensive treatment measures such as improving basic diseases,strengthening nutrition,using abdominal bands,and being unable to bear weight in the short term.