Reconstruction of infected complex abdominal wall defects with autogenous pedicled demucosalized small intestinal sheet.
BACKGROUND
Synthetic mesh can increase the risk of complications if it is placed directly over viscera or if the site is contaminated. Therefore, the use of bioprosthetic materials has increased rapidly. Neither synthetic nor bioprosthetic mesh is ideal for reconstructing infected complex abdominal wall defects. Our method using an autogenous pedicled demucosalized small intestinal sheet may be an alternative.


METHODS
Forty-one patients with infected, complex abdominal wall defects, with a mean defect size of 108 cm(2), underwent abdominal wall reconstruction using an autogenous, pedicled, demucosalized small intestinal sheet between January 1970 and December 2006. All patients had bowel and enterocutaneous fistulae in the defect. During operation, after resecting fistulae, the mucosa of the longitudinally split small intestine was scraped off with a scalpel to obtain an autogenous, pedicled, demucosalized small intestinal sheet, and then used to bridge the defect in the abdominal wall. A split thickness skin graft was then applied directly onto the demucosalized surface of the split bowel.


RESULTS
The operative procedure was successful in patients. The wounds between the intestinal sheets and abdominal walls healed spontaneously. Four patients developed regeneration of intestinal mucosa in some of the "meshed" skin grafts at 4-5 days postoperatively. The follow-up evaluation was 24 months to 20 years. Abdominal wall herniation, fistula formation, or bowel obstruction did not occur in these patients.


CONCLUSIONS
Autogenous, pedicled, demucosalized small intestinal sheets can be an effective method for reconstructing infected complex abdominal wall defects.
Liu
Lei
L
Medical School of Nanjing University, Nanjing Jinling Hospital, Research Institute of General Surgery, Nanjing, China.
Li
Jie Shou
JS
Li
Ning
N
Ren
Jian An
JA
Zhao
Yun Zhao
YZ
D034861:Abdominal Wall / Q000473:pathology* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D007413:Intestinal Mucosa / Q000601:surgery; D007421:Intestine, Small / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016038:Skin Transplantation; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult