Introduction:This study aimed to establish an animal model of open abdomen(OA)through temporary abdominal closure via different techniques.Methods:Adult male Sprague-Dawley rats were randomly divided into three groups...Introduction:This study aimed to establish an animal model of open abdomen(OA)through temporary abdominal closure via different techniques.Methods:Adult male Sprague-Dawley rats were randomly divided into three groups:group A(OA with polypropylene mesh alone);group B(OA with polypro-pylene mesh combined with a patch);and group C(OA with polypropylene mesh and a sutured patch).Vital signs,pathophysiological changes,and survival rates were closely monitored in the rats for 7 days after surgery.Abdominal X-rays and histopathological examinations were performed to assess abdominal organ changes and wound healing.Results:The results showed no significant difference in mortality rates among the three groups(p>0.05).However,rats in group B exhibited superior overall condi-tion,cleaner wounds,and a higher rate of wound healing compared to the other groups(p<0.05).Abdominal X-rays indicated that varying degrees of distal intestinal obstruction in all groups.Histopathological examinations revealed fibrous hyperpla-sia,inflammatory cell infiltration,neovascularization,and collagen deposition in all groups.Group B demonstrated enhanced granulation tissue generation,neovasculari-zation,and collagen deposition compared to the other groups(p<0.05).Conclusions:Polypropylene mesh combined with patches is the most suitable method for establishing an animal model of OA.This model successfully replicated the patho-logical and physiological changes in postoperative patients with OA,specifically the progress of abdominal skin wound healing.It provides a practical and reliable animal model for OA research.展开更多
The use of open abdomen(OA) as a technique in the treatment of exsanguinating trauma patients was first described in the mid-19 th century. Since the 1980 s, OA has become a relatively new and increasingly common stra...The use of open abdomen(OA) as a technique in the treatment of exsanguinating trauma patients was first described in the mid-19 th century. Since the 1980 s, OA has become a relatively new and increasingly common strategy to manage massive trauma and abdominal catastrophes. OA has been proven to help reduce the mortality of trauma. Nevertheless, the OA method may be associated with terrible and devastating complications such as enteroatmospheric fistula(EAF). As a result, OA should not be overused, and attention should be given to critical care as well as special management. The temporary abdominal closure(TAC) technique after abbreviated laparotomy was used to improve wound healing and facilitate final fascial closure of OA. Negative pressure therapy(NPT) is the most commonly used TAC method.展开更多
Background:Fluid overload(FO)after resuscitation is frequent and contributes to adverse outcomes among postinjury open abdomen(OA)patients.Bioelectrical impedance analysis(BIA)is a promising tool for monitoring fluid ...Background:Fluid overload(FO)after resuscitation is frequent and contributes to adverse outcomes among postinjury open abdomen(OA)patients.Bioelectrical impedance analysis(BIA)is a promising tool for monitoring fluid status and FO.Therefore,we sought to investigate the efficacy of BIA-directed fluid resuscitation among OA patients.Methods:A pragmatic,prospective,randomized,observer-blind,single-center trial was performed for all trauma patients requiring OA between January 2013 and December 2017 to a national referral center.A total of 140 postinjury OA patients were randomly assigned in a 1:1 ratio to receive either a BIA-directed fluid resuscitation(defined as BIA)protocol that included fluid administration with monitoring of hemodynamic parameters and different degrees of interventions to achieve a negative fluid balance targeting the hydration level(HL)measured by BIA or a traditional fluid resuscitation(TRD)in which clinicians determined the fluid resuscitation regimen according to traditional parameters during 30 d of intensive care unit(ICU)management.The primary outcome was the 30-day primary fascial closure(PFC)rate.The secondary outcomes included the time to PFC,postoperative 7-day cumulative fluid balance(CFB)and adverse events within 30 d after OA.The Kaplan–Meier method and the log-rank test were utilized for PFC after OA.A generalized linear regression model for the time to PFC and CFB was built.Results:A total of 134 patients completed the trial(BIA,n=66;TRD,n=68).The BIA patients were significantly more likely to achieve PFC than the TRD patients(83.33%vs.55.88%,P<0.001).In the BIA group,the time to PFC occurred earlier than that of the TRD group by an average of 3.66 d(P<0.001).Additionally,the BIA group showed a lower postoperative 7-day CFB by an average of 6632.80 ml(P<0.001)and fewer complications.Conclusions:Among postinjury OA patients in the ICU,the use of BIA-guided fluid resuscitation resulted in a higher PFC rate and fewer severe complications than the traditional fluid resuscitation strategy.展开更多
BACKGROUND Open abdomen(OA) has been generally accepted for its magnificent superiority and effectiveness in patients with severe trauma, severe intra-abdominal infection, and abdominal compartment syndrome. In the me...BACKGROUND Open abdomen(OA) has been generally accepted for its magnificent superiority and effectiveness in patients with severe trauma, severe intra-abdominal infection, and abdominal compartment syndrome. In the meantime, OA calls for a mass of nursing and the subsequent enteroatomospheric fistula(EAF), which is one of the most common complications of OA therapy, remains a thorny challenge.CASE SUMMARY Our team applied thermoplastic polyurethane as a befitting material for producing a 3 D-printed "fistula stent" in the management of an EAF patient,who was initially admitted to local hospital because of abdominal pain and distension and diagnosed with bowel obstruction. After a series of operations and OA therapy, the patient developed an EAF.CONCLUSION Application of this novel "fistula stent" resulted in a drastic reduction in the amount of lost enteric effluent and greatly accelerated rehabilitation processes.展开更多
Background: Despite increasing survival following damage control laparotomy and open abdomen technique, little is known about the biology of visceral skin graft revascularization and separation from peritoneal content...Background: Despite increasing survival following damage control laparotomy and open abdomen technique, little is known about the biology of visceral skin graft revascularization and separation from peritoneal contents. Methods: Following laparotomy for trauma, patients with visceral edema preventing fascial closure underwent Vicryl mesh closure followed by visceral split-thickness skin grafting and readmission graft excision and abdominal wall reconstruction. Utilizing laser speckle contrast imaging, immunochemical staining of histologic sections, and RT-PCR array technology, we examined the revascularization, microvascular anatomy, morphology, and change in gene expression of visceral skin grafts. Results: Ten patients ranging in age from 25 to 46 years underwent visceral grafting for cutaneous coverage of an open abdomen. Skin graft perfusion peaked at a mean of 350 PU by post-operative day 14 synchronous with closure of meshed interstices, and remained constant until excision. Time to graft excision ranged from 6 to 18 months. CD-31 immunostaining documented a significant (p = 0.04) increase in vascular surface area in excised grafts compared to control skin. Trichrome staining revealed an 8-fold increase in excised graft thickness. Mesothelial cells were identified within the dermal matrix of excised grafts. RT-PCR demonstrated significant up-regulation of genes involved in matrix structure and remodeling, cytoskeleton regulation, and WNT signaling;and down-regulation of genes involved in inflammation and matrix proteolysis in excised grafts compared to control skin. Conclusion: Our data document early visceral skin graft perfusion and a plateau in revascularization. Histology reveals a robust dermal matrix populated by fibroblasts and mesothelial cells within a complex supporting vascular network. Genetic analysis of excised grafts reveals growth factor, collagen, and matrix remodeling gene expression.展开更多
Blunt bowel injury(BBI)is relatively rare but life-threatening when delayed in surgical repair or anas-tomosis.Providing enteral nutrition(EN)in BBI patients with open abdomen after damage control surgery is challengi...Blunt bowel injury(BBI)is relatively rare but life-threatening when delayed in surgical repair or anas-tomosis.Providing enteral nutrition(EN)in BBI patients with open abdomen after damage control surgery is challenging,especially for those with discontinuity of the bowel.Here,we report a 47-year-old male driver who was involved in a motor vehicle collision and developed ascites on post-trauma day 3.Emergency exploratory laparotomy at a local hospital revealed a complete rupture of the jejunum and then primary anastomosis was performed.Postoperatively,the patient was transferred to our trauma center for septic shock and hyperbilirubinemia.Following salvage resuscitation,damage control lapa-rotomy with open abdomen was performed for abdominal sepsis,and a temporary double enterostomy(TDE)was created where the anastomosis was ruptured.Given the TDE and high risk of malnutrition,multiple portions EN were performed,including a proximal portion EN support through a nasogastric tube and a distal portion EN via a jejunal feeding tube.Besides,chyme delivered from the proximal portion of TDE was injected into the distal portion of TDE via a jejunal feeding tube.Hyperbilirubinemia was alleviated with the increase in chyme reinfusion.After 6 months of home EN and chyme reinfusion,the patient finally underwent TDE reversal and abdominal wall reconstruction and was discharged with a regular diet.For BBI patients with postoperative hyperbilirubinemia who underwent open abdomen,the combination of multiple portions EN and chyme reinfusion may be a feasible and safe option.展开更多
The so-called 'burst abdomen' has been described for many years and is a well-known clinical condition, whereas the concept of the 'open abdomen' is relatively new. In clinical practice, both nosologic...The so-called 'burst abdomen' has been described for many years and is a well-known clinical condition, whereas the concept of the 'open abdomen' is relatively new. In clinical practice, both nosological entities are characterized by a complex spectrum of symptoms apparently disconnected, which in many cases poses a great challenge for surgical repair. In order to assess the management of these disorders in a more comprehensive and integral fashion, the concept of 'acute postoperative open abdominal wall'(acute POAW) is presented, which in turn can be divided into 'intentional' or planned acute POAW and 'unintentional' or unplanned POAW. The understanding of the acute POAW as a single clinical process not only allows a better optimization of the ther-apeutic approach in the surgical repair of abdominal wallrelated disorders, but also the stratification and collection of data in different patient subsets, favoring a better knowledge of the wide spectrum of conditions involved in the surgical reconstruction of the abdominal wall.展开更多
BACKGROUND Abdominal Clostridium perfringens(C. perfringens) gas gangrene is a rare infection that has been described in the literature as most frequently occurring in postoperative patients with open trauma. Intra-ab...BACKGROUND Abdominal Clostridium perfringens(C. perfringens) gas gangrene is a rare infection that has been described in the literature as most frequently occurring in postoperative patients with open trauma. Intra-abdominal gas gangrene caused by C.perfringens infection after closed abdominal injury is extremely rare, difficult to diagnose, and progresses rapidly with high mortality risk. Here, we report a case of C. perfringens infection caused by closed abdominal injury.CASE SUMMARY A 54-year-old male suffered multiple intestinal tears and necrosis after sustaining an injury caused by falling from a high height. These injuries and the subsequent necrosis resulted in intra-abdominal C. perfringens infection. In the first operation,we removed the necrotic intestinal segment, kept the abdomen open and covered the intestine with a Bogota bag. A vacuum sealing drainage system was used to cover the outer layer of the Bogota bag, and the drainage was flushed under negative pressure. The patient was transferred to the intensive care unit for supportive care and empirical antibiotic treatment. The antibiotics were not changed until the results of bacterial culture and drug susceptibility testing were obtained.Two consecutive operations were then performed due to secondary intestinal necrosis. After three definitive operations, the patient successfully survived the perioperative period. Unfortunately, he died of complications related to GuillainBarre syndrome 75 d after the first surgery. This paper presents this case of intraabdominal gas gangrene infection and analyzes the diagnosis and treatment based on a review of current literature.CONCLUSION When the intestines rupture leading to contamination of the abdominal cavity by intestinal contents, C. perfringens bacteria normally present in the intestinal tract may proliferate in large numbers and lead to intra-abdominal infection. Prompt surgical intervention, adequate drainage,appropriate antibiotic therapy, and intensive supportive care comprise the most effective treatment strategy. If the abdominal cavity is heavily contaminated, an open abdominal approach may be a beneficial treatment.展开更多
随着社会经济的快速发展、汽车的增多,交通伤等多种复杂致伤因素导致的创伤病例越来越多。近年来损伤控制性手术(damage control surgery,DCS)用于创伤治疗,提高了严重多发伤患者抢救的成功率。本文主要介绍损伤控制性手术的发展历程,...随着社会经济的快速发展、汽车的增多,交通伤等多种复杂致伤因素导致的创伤病例越来越多。近年来损伤控制性手术(damage control surgery,DCS)用于创伤治疗,提高了严重多发伤患者抢救的成功率。本文主要介绍损伤控制性手术的发展历程,阐述其临床应用及研究进展。展开更多
基金Postgraduate Research&Practice Innovation Program of Jiangsu Province,Grant/Award Number:SJCX23_0092National Natural Science Foundation of China,Grant/Award Number:82270595Jiangsu Provincial Medical Innovation Center,Grant/Award Number:CXZX202217。
文摘Introduction:This study aimed to establish an animal model of open abdomen(OA)through temporary abdominal closure via different techniques.Methods:Adult male Sprague-Dawley rats were randomly divided into three groups:group A(OA with polypropylene mesh alone);group B(OA with polypro-pylene mesh combined with a patch);and group C(OA with polypropylene mesh and a sutured patch).Vital signs,pathophysiological changes,and survival rates were closely monitored in the rats for 7 days after surgery.Abdominal X-rays and histopathological examinations were performed to assess abdominal organ changes and wound healing.Results:The results showed no significant difference in mortality rates among the three groups(p>0.05).However,rats in group B exhibited superior overall condi-tion,cleaner wounds,and a higher rate of wound healing compared to the other groups(p<0.05).Abdominal X-rays indicated that varying degrees of distal intestinal obstruction in all groups.Histopathological examinations revealed fibrous hyperpla-sia,inflammatory cell infiltration,neovascularization,and collagen deposition in all groups.Group B demonstrated enhanced granulation tissue generation,neovasculari-zation,and collagen deposition compared to the other groups(p<0.05).Conclusions:Polypropylene mesh combined with patches is the most suitable method for establishing an animal model of OA.This model successfully replicated the patho-logical and physiological changes in postoperative patients with OA,specifically the progress of abdominal skin wound healing.It provides a practical and reliable animal model for OA research.
文摘The use of open abdomen(OA) as a technique in the treatment of exsanguinating trauma patients was first described in the mid-19 th century. Since the 1980 s, OA has become a relatively new and increasingly common strategy to manage massive trauma and abdominal catastrophes. OA has been proven to help reduce the mortality of trauma. Nevertheless, the OA method may be associated with terrible and devastating complications such as enteroatmospheric fistula(EAF). As a result, OA should not be overused, and attention should be given to critical care as well as special management. The temporary abdominal closure(TAC) technique after abbreviated laparotomy was used to improve wound healing and facilitate final fascial closure of OA. Negative pressure therapy(NPT) is the most commonly used TAC method.
基金supported by grants from the National Natural Science Foundation of China(81770532,WDD)the Jiangsu Province Medical Foundation for Youth Talents(QNRC2016901,WDD)。
文摘Background:Fluid overload(FO)after resuscitation is frequent and contributes to adverse outcomes among postinjury open abdomen(OA)patients.Bioelectrical impedance analysis(BIA)is a promising tool for monitoring fluid status and FO.Therefore,we sought to investigate the efficacy of BIA-directed fluid resuscitation among OA patients.Methods:A pragmatic,prospective,randomized,observer-blind,single-center trial was performed for all trauma patients requiring OA between January 2013 and December 2017 to a national referral center.A total of 140 postinjury OA patients were randomly assigned in a 1:1 ratio to receive either a BIA-directed fluid resuscitation(defined as BIA)protocol that included fluid administration with monitoring of hemodynamic parameters and different degrees of interventions to achieve a negative fluid balance targeting the hydration level(HL)measured by BIA or a traditional fluid resuscitation(TRD)in which clinicians determined the fluid resuscitation regimen according to traditional parameters during 30 d of intensive care unit(ICU)management.The primary outcome was the 30-day primary fascial closure(PFC)rate.The secondary outcomes included the time to PFC,postoperative 7-day cumulative fluid balance(CFB)and adverse events within 30 d after OA.The Kaplan–Meier method and the log-rank test were utilized for PFC after OA.A generalized linear regression model for the time to PFC and CFB was built.Results:A total of 134 patients completed the trial(BIA,n=66;TRD,n=68).The BIA patients were significantly more likely to achieve PFC than the TRD patients(83.33%vs.55.88%,P<0.001).In the BIA group,the time to PFC occurred earlier than that of the TRD group by an average of 3.66 d(P<0.001).Additionally,the BIA group showed a lower postoperative 7-day CFB by an average of 6632.80 ml(P<0.001)and fewer complications.Conclusions:Among postinjury OA patients in the ICU,the use of BIA-guided fluid resuscitation resulted in a higher PFC rate and fewer severe complications than the traditional fluid resuscitation strategy.
文摘BACKGROUND Open abdomen(OA) has been generally accepted for its magnificent superiority and effectiveness in patients with severe trauma, severe intra-abdominal infection, and abdominal compartment syndrome. In the meantime, OA calls for a mass of nursing and the subsequent enteroatomospheric fistula(EAF), which is one of the most common complications of OA therapy, remains a thorny challenge.CASE SUMMARY Our team applied thermoplastic polyurethane as a befitting material for producing a 3 D-printed "fistula stent" in the management of an EAF patient,who was initially admitted to local hospital because of abdominal pain and distension and diagnosed with bowel obstruction. After a series of operations and OA therapy, the patient developed an EAF.CONCLUSION Application of this novel "fistula stent" resulted in a drastic reduction in the amount of lost enteric effluent and greatly accelerated rehabilitation processes.
文摘Background: Despite increasing survival following damage control laparotomy and open abdomen technique, little is known about the biology of visceral skin graft revascularization and separation from peritoneal contents. Methods: Following laparotomy for trauma, patients with visceral edema preventing fascial closure underwent Vicryl mesh closure followed by visceral split-thickness skin grafting and readmission graft excision and abdominal wall reconstruction. Utilizing laser speckle contrast imaging, immunochemical staining of histologic sections, and RT-PCR array technology, we examined the revascularization, microvascular anatomy, morphology, and change in gene expression of visceral skin grafts. Results: Ten patients ranging in age from 25 to 46 years underwent visceral grafting for cutaneous coverage of an open abdomen. Skin graft perfusion peaked at a mean of 350 PU by post-operative day 14 synchronous with closure of meshed interstices, and remained constant until excision. Time to graft excision ranged from 6 to 18 months. CD-31 immunostaining documented a significant (p = 0.04) increase in vascular surface area in excised grafts compared to control skin. Trichrome staining revealed an 8-fold increase in excised graft thickness. Mesothelial cells were identified within the dermal matrix of excised grafts. RT-PCR demonstrated significant up-regulation of genes involved in matrix structure and remodeling, cytoskeleton regulation, and WNT signaling;and down-regulation of genes involved in inflammation and matrix proteolysis in excised grafts compared to control skin. Conclusion: Our data document early visceral skin graft perfusion and a plateau in revascularization. Histology reveals a robust dermal matrix populated by fibroblasts and mesothelial cells within a complex supporting vascular network. Genetic analysis of excised grafts reveals growth factor, collagen, and matrix remodeling gene expression.
基金Grants from the National Natural Science Foundation of China(Grant No.82270587)the Jinling Hospital Scientific Research Project(Grant No.YYZD2021011).
文摘Blunt bowel injury(BBI)is relatively rare but life-threatening when delayed in surgical repair or anas-tomosis.Providing enteral nutrition(EN)in BBI patients with open abdomen after damage control surgery is challenging,especially for those with discontinuity of the bowel.Here,we report a 47-year-old male driver who was involved in a motor vehicle collision and developed ascites on post-trauma day 3.Emergency exploratory laparotomy at a local hospital revealed a complete rupture of the jejunum and then primary anastomosis was performed.Postoperatively,the patient was transferred to our trauma center for septic shock and hyperbilirubinemia.Following salvage resuscitation,damage control lapa-rotomy with open abdomen was performed for abdominal sepsis,and a temporary double enterostomy(TDE)was created where the anastomosis was ruptured.Given the TDE and high risk of malnutrition,multiple portions EN were performed,including a proximal portion EN support through a nasogastric tube and a distal portion EN via a jejunal feeding tube.Besides,chyme delivered from the proximal portion of TDE was injected into the distal portion of TDE via a jejunal feeding tube.Hyperbilirubinemia was alleviated with the increase in chyme reinfusion.After 6 months of home EN and chyme reinfusion,the patient finally underwent TDE reversal and abdominal wall reconstruction and was discharged with a regular diet.For BBI patients with postoperative hyperbilirubinemia who underwent open abdomen,the combination of multiple portions EN and chyme reinfusion may be a feasible and safe option.
文摘The so-called 'burst abdomen' has been described for many years and is a well-known clinical condition, whereas the concept of the 'open abdomen' is relatively new. In clinical practice, both nosological entities are characterized by a complex spectrum of symptoms apparently disconnected, which in many cases poses a great challenge for surgical repair. In order to assess the management of these disorders in a more comprehensive and integral fashion, the concept of 'acute postoperative open abdominal wall'(acute POAW) is presented, which in turn can be divided into 'intentional' or planned acute POAW and 'unintentional' or unplanned POAW. The understanding of the acute POAW as a single clinical process not only allows a better optimization of the ther-apeutic approach in the surgical repair of abdominal wallrelated disorders, but also the stratification and collection of data in different patient subsets, favoring a better knowledge of the wide spectrum of conditions involved in the surgical reconstruction of the abdominal wall.
文摘BACKGROUND Abdominal Clostridium perfringens(C. perfringens) gas gangrene is a rare infection that has been described in the literature as most frequently occurring in postoperative patients with open trauma. Intra-abdominal gas gangrene caused by C.perfringens infection after closed abdominal injury is extremely rare, difficult to diagnose, and progresses rapidly with high mortality risk. Here, we report a case of C. perfringens infection caused by closed abdominal injury.CASE SUMMARY A 54-year-old male suffered multiple intestinal tears and necrosis after sustaining an injury caused by falling from a high height. These injuries and the subsequent necrosis resulted in intra-abdominal C. perfringens infection. In the first operation,we removed the necrotic intestinal segment, kept the abdomen open and covered the intestine with a Bogota bag. A vacuum sealing drainage system was used to cover the outer layer of the Bogota bag, and the drainage was flushed under negative pressure. The patient was transferred to the intensive care unit for supportive care and empirical antibiotic treatment. The antibiotics were not changed until the results of bacterial culture and drug susceptibility testing were obtained.Two consecutive operations were then performed due to secondary intestinal necrosis. After three definitive operations, the patient successfully survived the perioperative period. Unfortunately, he died of complications related to GuillainBarre syndrome 75 d after the first surgery. This paper presents this case of intraabdominal gas gangrene infection and analyzes the diagnosis and treatment based on a review of current literature.CONCLUSION When the intestines rupture leading to contamination of the abdominal cavity by intestinal contents, C. perfringens bacteria normally present in the intestinal tract may proliferate in large numbers and lead to intra-abdominal infection. Prompt surgical intervention, adequate drainage,appropriate antibiotic therapy, and intensive supportive care comprise the most effective treatment strategy. If the abdominal cavity is heavily contaminated, an open abdominal approach may be a beneficial treatment.
