PrimaryCongenital abdominal Wall Repair Using Human Acellular Dermal Matrix ( HADM ) :a7 Cases Report
Runing rubric: Abdominal Wall Repair With Acellular Matrix
1.Human acellular cuticular matrix ( HADM ) can mend the primary inborn abdominal wall defect.
2.HADM can efficaciously increase the abdominal volume, diminish the UBP, decrease the hazard of ventral hernia and lower the incidence of reoperation.
3.HADM usage is safe in abdominal wall Reconstructions.
Aim:The intent of this survey is to describe the initial consequences of primary Congenital abdominal Wall Repair utilizing human noncellular dermal matrix in newborn.
Methods:We retrospectively reviewed 7 patients who were underwent an abdominal wall defect fix with human noncellular dermal matrix ( HADM ) spot in our infirmary between May 2008 and November 2012. The demographics, complications and the follow-up information of patients were analyzed.
Consequences:Abdominal wall defect can be repaired with human noncellular dermal matrix and all the urinary vesica force per unit area ( UBP ) was lower than 30 cmH2O. One patient with bosom disease was failed and other 6 patients were survived after surgery. Incision split was observed in 2 patients 14 yearss after operation. No ventral hernia was seen during the follow up period ( 6 month-3 old ages ) in all the survival patients.
Decisions:HADM can mend the primary inborn abdominal wall defect. HADM can efficaciously increase the abdominal volume, diminish the UBP, decrease the hazard of ventral hernia and lower the incidence of reoperation. Human noncellular corium usage is safe in abdominal wall Reconstructions.
Keywords:human noncellular dermal matrix, primary Congenital abdominal Wall defect, complications, newborn.
Gastroschisis is one of the most common inborn abdominal wall defects, which occurs in 1 in 4000 unrecorded births [ 1 ] . It is caused by underdevelopment of the sidelong wall during the early embryologic period. The chief clinical characteristic of gastroschisis is that freely drifting cringles of intestine within the amnionic fluid with an abdominal wall defect to the right of the interpolation of the umbilical cord [ 2 ] . Several ways have been described to pull off this disease, such as staged silo closing, unreal stuffs patch fix, sutureless intestine decrease and etc [ 3-4 ] . Recently, utilizing the human acelllular dermal matrix for gastroschisis has been decribed and the reported result is really good [ 5 ] .
Here, we retrospectively reviewed 7 patients who were underwent an abdominal wall defect fix with human noncellular dermal matrix ( HADM ) spot in our infirmary between May 2008 and November 2012. The result of the patients and the efficaciousness of HADM were evaluated in the undermentioned text.
Materials and Methods
The records of all patients who underwent abdominal wall Reconstruction utilizing human noncellular dermal matrix ( Beijing Qingyuanweiye Bio-Tissue Engineering CO. , LTD, China ) ( Figure 1A ) between May 2008 and November 2012 were assessed retrospectively. The protocol was approved by our Hospital Review Board and the written informed consent was provided by patients. For each patient, the following informations were collected: age, sex, weight, fascial defect diameter, comorbidities, complications and their interventions, postoperative lesion attention, and length of infirmary stay. All patients were followed up ( 6 month- 3 old ages ) after surgery and the patients were examined and any complications or findings of hernia return were recorded.
After admittance into the infirmary, the patients were processed with fasting, GI decompression, stomachic content extraction, ureteral stent arrangement, vesica empty and anal dilation for laxation. The open organ decrease was fail beside bed. Then the patients were anesthesia by endotracheal cannulation and a piezometer tubing connected with a force per unit area transducer was placed transurethral on the patients. The open splanchnic variety meats and the environing tegument were cleaned with 0.1 % Iodophors and covered with sterilised towel. An scratch was made to expose the abdominal wall along the right side of defect wall. The abdominal defect wall and pit were enlarged to transport out the splanchnic variety meats decrease. The belly closing was processed by pulling the up and lower abdominal wall together. The urinary vesica force per unit area ( UBP ) was monitored and the biological spot fix was determined if the UBP & A ; gt ; 30 centimeter H2O. The tegument and the hypodermic tissue were separated. Then the human noncellular dermal matrix spot was sutured with deep facia and abdominal wall. The scratch was covered with the spot and the tegument was to the full enlarged ( a perpendicular relaxation scratch was made on midaxillary line if necessary ) to do certain the spot can be covered. The surgical procedure was showed in Figure 1B.
The informations were presented by average ± SD or average ( scope ) .
Preoperative informations of the Patients
The patient characteristic before operation was presented in Table 1.There were 5 males and 2 females in these patients. The average Age was 8 H ( 6-26h ) and the weight scope was 1.8-2.2 kilogram. The defect wall diameter was 3.0-4.5 centimeter. The open splanchnic organ included tummy, little bowel, colon etc. Adhesive intestinal obstruction can be observed and exposed variety meats were covered with thick mossy secreta ( Figure 2A ) . One patient had bosom disease comorbidity. Other comorbidities such as enteric atresia or stricture or Meckel’s diverticulum were non observed.
Postoperative informations of the patients
All the 7 patients were process the surgery with human noncellular dermal matrix and the UBP & A ; lt ; 30 centimeter H2Oxygen after the surgery ( Figure 2B ) . One patient was given up the intervention due to the bosom disease. The other 6 patients were processed swimmingly from anti-infection, mechanical airing and parenternal nutrition to unwritten eating. The item informations were showed in Table 2. Two patients were presented with open spot on the tegument scratch when taking the suturas 14 yearss postoperation. The patients were followed up from 6 month to 3 old ages and no adhesive intestinal obstruction or ventral hernia was observed.
We presented here is a information reappraisal about 7 instances gastroschisis processed with human noncellular dermal matrix in our infirmary. The consequences showed that no terrible complication was observed in all 6 patients ( one patient with inborn bosom disease was excluded ) . Two patients were presented with open spot on the skin scratch at clip of taking the suturas 14 yearss postoperation. The patients were followed up from 6 month to 3 old ages and no adhesive intestinal obstruction or ventral hernia was observed.
As a rare seen disease in newborn, the incidence of gastroschisis has increased over the past few decennaries [ 3 ] . However, the etiology of the disease has been to the full determined yet. Mac Bird et Al [ 6 ] showed that adult females who used baccy, intoxicant, and isobutylphenyl propionic acid during early gestation have a reasonably increasedriskofgastroschisis. Primary spot fix is thought manner to pull off the abdominal wall defect and reconstruct the variety meats. However, 40 % -50 % of the foetal patients can’t endure the primary spot fix because forceful closing of the abdominal will take to lift of stop, airflow restriction and venous return stagnancy and terrible complication will besides come along [ 7 ] . Kidd et al [ 8 ] compared staged closing method of gastroschisis with primary closing and found that a higher incidence of intestine stricture, necrotizing enterocolitis and reoperation has madeprimaryclosureof gastroschisis. The incidence of complications in staged and primary closing was 20 % and 15 % , severally ( P & A ; lt ; 0.001 ) . Staged silo closing can avoid the complete lift of the abdominal force per unit area, efficaciously perfuse the splanchnic variety meats with blood supply, diminish the incidence of abdominal compartment syndrome [ 9 ] . However, Staged silo closing still has some disadvantages, such as increasing the incidence of sepsis, prolong the continuance of parenteral nutrition and mechanical airing, and demand of reoperation [ 10 ] .
With the development of tissue technology, the application of noncellular biological tissue spot in clinic has been increased significantly [ 11 ] . The cardinal point of abdominal fix surgery is to diminish the abdominal force per unit area every bit much as possible. The biological spot has good biocompatibility and it can increase the volume of the abdominal pit and lessening force per unit area inside the pit [ 11 ] . Furthermore, the tenseness strength is suited for the inborn abdominal wall defect fix. Chin et al [ 12 ] suggested the patients who have abdominal force per unit area & A ; lt ; 20 centimeter H2O are suited for the blood perfusion and have a lower hazard of abdominal compartment syndrome. Vegunta et al [ 13 ] showed that UBP is an indicant of abdominal force per unit area and UBP?30 centimeter H2O is supervising index of primary closing. The information here indicated that the UBP & A ; lt ; 30 centimeter H2O after spot fix. Since the splanchnic variety meats are exposed outside, abdominal wall fix is a contaminative operation. The gush can be found between the spot and tegument after the surgery and the arrangement of the drainage spot for 48 H will avoid the hazard of gush. During the early phase of the operation, the spot was non closely adhered to the tegument and the skin scratch was unstable. Therefore, the clip of sutura removing was normally subsequently. Two patients without drainage spot arrangement showed scratch split. Then we used the absorbable sutura to make the tegument closing and the no scratch split was happened once more. Harmonizing to the carnal theoretical account consequence, these noncellular spot can bring on the regeneration of the tissue, degrade with the freshly grown tissue, replaced by connective tissue and carry through the fix of the defect [ 14 ] . From our informations, no adhesive intestinal obstruction or ventral hernia was observed during the 6 month – 3 old ages follow-up. However, this still necessitate to be confirmed by farther observation based on longer follow-up informations.