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| 題 名 | Bilateral Bipedicled Fasciocutaneouse Flaps for Closure of a Giant Abdominal Wall Defect in a Three-year-old Pediatric Patient=使用雙側雙血管蒂皮筋膜皮瓣覆蓋一位三歲女孩腹壁大面積缺損 |
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| 作 者 | 楊舒鈞; 張家寧; 陳宏基; | 書刊名 | 臺灣整形外科醫學會雜誌 |
| 卷 期 | 22:3 2013.09[民102.09] |
| 頁 次 | 頁237-242 |
| 分類號 | 416.413 |
| 關鍵詞 | 腹壁缺損; 雙側雙血管蒂皮筋膜皮瓣; Abdominal wall defect; Bipedicled fasciocutaneous flaps; |
| 語 文 | 英文(English) |
| 中文摘要 | 背景:有著腹壁缺損的嬰孩,無論是先天性或剖腹手術後造成的,對醫療人員而言,在照護上或是考慮手術修復都是非常棘手的問題。文獻上對於嬰孩的腹部缺損發表了許多處理的方式,然而並沒有一種手術修復是最好的。而我們所做的此種用皮筋膜皮瓣可一階段地修補孩童的腹壁缺損更是文獻上罕見之方式。目的及目標:在此我們提出一個立即性修補腹壁缺損的可行方法,並分享我們的術前計畫、皮瓣設計、治療經驗及成果。材料及方法:一位三歲女童於法洛氏四合症術後併發胸部及腹部腔室症候群。為了釋放其腔室壓力,心臟血管外科醫師緊急做了上腹部筋膜切開術,造成其腹壁缺損併肝臟外露。為了立即解決此一問題,我們使用雙側雙血管蒂皮筋膜皮瓣覆蓋此女童之大面積的腹壁缺損。結果:僅需二小時之手術過程我們就解決了此女童之大面積上腹壁缺損併臟器外露問題。由於此皮筋膜皮瓣僅帶有皮層及淺筋膜層,其富有彈性與高順應性之特性可容忍升高之腹內壓,使腹腔壓力維持於正常範圍內。女童於術後第八天開始經腸道進食,術後傷口癒合良好,於住院期間或術後第六個月追蹤除了有術前即預計之腹壁疝氣外,其他均無併發症出現。結論:有著腹壁缺損的嬰孩常合併有其他系統性疾病,盡可能地修復其缺損之腹壁可減少其他合併症之發生以增加存活率及照護之品質。使用雙側雙血管蒂皮筋膜皮瓣是一簡單、快速、毋須顯微技術、及術後方便照護的腹壁修復方式,並達到滿意之結果,例如:其提供一富於彈性之覆蓋可順應腹內壓之變化、可維持腹部外觀之完整性、快速恢復腸道功能、減少腹膜炎發生機會,及保護腹腔內臟器。 |
| 英文摘要 | Background:Infants or younger children with abdominal wall defects, which are either congenital or following laparotomy, are both critical and difficult conditions to solve. To repair a large abdominal wall defect is also a challenging issue for plastic surgeons. Several methods, from temporary to primary closure, to manage an open abdominal wound in children are discussed in the literature. However, there is no consensus on which one is the best way to close the abdominal defect. One-staged coverage with a fasciocutaneous flap is rarely reported.Aim and Objectives:Herein we present a practical method to cover a large abdominal wall defect with bilateral bipedicled fasciocutaneous flaps., and share our experience of managing such a case. Preoperative planning, flap designs, and postoperative outcome are discussed.Materials and Methods:A three-year-old girl had chest and abdominal compartment syndrome following cardiac surgery of Tetralogy of Fallot. After abdominal fasciotomy made by the cardiac surgeons in order to relieve the intra-abdominal pressure, a large abdominal wall defect with liver exposure was left. A Bogota bag was used for temporary coverage of the abdominal defect. To reduce the risk of peritonitis and for better care quality, plastic and reconstructive surgeons were consulted to solve this critical condition. Bilateral bipedicled fasciocutaneous flaps were employed to cover the abdominal wall defect immediately.Results:It only took less than two hours to complete the coverage of the large abdominal defect and solve the problem of visceral exposure. The patient started enteral feeding on postoperative eighth day. This fasciocutaneous flaps provided an elastic coverage of the viscera and also kept the intra-abdominal pressure within normal range. No complications occurred during hospitalization or on follow-up.Conclusion:Infants or younger children with a large abdominal wall defect also have other systemic critical conditions. To reduce the risks of comorbidity and better care quality, temporary or primary closure of the defect is important. Our method of using bilateral bipedicled fasciocutaneous flaps for primary and secure closure of a large abdominal wall defect is simple and quick. |
本系統中英文摘要資訊取自各篇刊載內容。