ABSTRACT
A 39-year-old man was found to have left iliac artery rupture, and was transferred to our department. Emergency surgical repair was done, however, his intra- and postoperative condition precluded primary abdominal closure. On the 8th postoperative day, temporary abdominal closure (TAC) was performed using Composix Mesh TM and negative pressure wound therapy (NPWT). On the 19th day after the first surgery, an emergency reoperation was needed because of the rupture of the common hepatic artery aneurysm, of which there was no finding on admission. After the reoperation of the hepatic artery aneurysm, TAC was again performed using new Composix Mesh. On the 43rd day after the first surgery, the abdominal wall reconstruction without Composix Mesh was done using components separation and the anterior rectus abdominis sheath turnover flap method. On the 106th day after the first surgery, he had recovered well and was discharged. The genetic testing revealed COL3A1 mutation, which is specific for vascular type Ehlers-Danlos syndrome. When long-term open abdominal management is necessary after the abdominal aortic surgery, TAC with Composix Mesh and NPWT may be a useful alternative. Artery rupture in young people is a finding that should be considered suspicious for vascular type Ehlers-Danlos syndrome, which is difficult to treat.
ABSTRACT
Objective To investigate the clinical efficacy of allogeneic cross-linked dermal dressing (ACLD) for the treatment of enteroatmospheric fistula (EAF) in patients with open abdomen (OA).Methods The clinical data of 44 patients with experienced trauma who received OA at Nanjing General Hospital of Nanjing Military Command from January 2011 to January 2014 were retrospectively analyzed.All patients received temporary abdominal closure (TAC) by modified sandwich-vacuum package (MSVP).From January 2011 to December 2012,33 patients with OA received vaseline gauze as abdominal cover layer (VG group),and from January 2013 to January 2014,11 patients with OA received allogeneic cross-linked dermal dressing as abdominal cover layer (ACLD group).Patients were followed up via outpatient examination or telephone interview till October 2014.The incidence of EAF,time for skin-grafting,hematologic indexes in 2 weeks after surgery (white blood cell counts,percentage of neutrophil,the mean value of procalcitonin and C reactive protein),the duration of postoperative hospital stay,hospital expenses and survival rates in the 2 groups were analyzed using t-test,repeated measures analysis of variance and Fisher's exact test.Results The incidence of EAF in the VG group and ACLD group was 42.4％ (14/33) and 0,respectively,with a significant difference between the 2 groups (P ＜ 0.05).The duration of skin-grafting was (15 ±6) days in the VG group and (11 ±3)days in the ACLD group,with a significant difference between the 2 groups (t =2.10,P ＜ 0.05).The mean values of preoperative procalcitonin and postoperative procalcitonin at day 1,3,7,14 in the VG group were (1.20 ± 0.60)pg,/L and (2.50-± 0.90)pg,/L,(1.70 ± 0.30) pg/L,(1.90 ± 0.40) μg/L and (2.70 ± 0.60) μg/L,which were significantly higher than that of (0.90 ± 0.30) μg/L and (1.80 ± 0.60) μg/L,(1.30 ± 0.50) μg/L,(0.60 ± 0.20) μg/L and (0.30 ± 0.07) μg/L in the ACLD group (F =8.50,P ＜ 0.05).The white blood cell counts and percentage of neutrophil and the percentage of C reactive protein between the 2 groups were changed from (13.8 ±2.4) × 109/L,(12.9 ± 2.1) × 109/L,0.90±0.09,0.88 ±0.06,(81 ± 19)mg/L,(136 ±28)mg/L to (16.2 ±3.3) × 109/L,(7.9 ± 3.0) x 109/L,0.85 ±0.12,0.79 ±0.09,(131 ±30)mg/L,(59 ±22)mg/L at postoperative day 14,showing no significant difference between the 2 groups (F =3.10,0.50,1.20,P ＞ 0.05).Duration of hospital stay and hospital expenses in the VG group and ACLD group were (137 ±32)days,(638 831 ± 113 670) yuan and (82 ± 44)days,(474 839 ± 78 543)yuan,respectively,with a significant difference between the 2 groups (t =3.60,4.43,P ＜ 0.05).The time of follow-up and overall survival rate in the VG group and ACLD group were 29 to 38 months and 81.8％ (27/33),and 10 to 20 months and 90.9％ (10/11),respectively,with no significant difference (P ＞ 0.05).Conclusion Allogeneic cross-linked dermal dressing as abdominal cover layer can effectively decrease EAF in patients with open abdomen.