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廣範圍 腸壁 損傷의 外科的 處置에 關한 硏究 Repair of Massive Abdominal Wall Defect

대한외과학회지 1974년 16권 2호 p.23 ~ 26
강중신,
소속 상세정보
강중신 (  ) 
대구동산기독병원 외과

Abstract


The proper and early repair of abdominal wall following gun shot wound, gas gangrene of the abdominal wall and excision of the malignant the abdominal lesion, etc. has been one of the difficult problems in the surgical field.
Four groups of adult New Zealand white rabbits (average weight 3.0 kg) were studied to characterize the natural history of full thickness abdominal wail replacement with Silastic Sheets.
All had standard 6.0 X 8. 0cm full thickness abdominal wall excisions. Different repairs were dome using Dacron reinforced Silastic Sheets (0.04 inch thickness, Dow. Corning Co, Model 501 -7-1, Group l had no surgical repair and daily dressing of the wound alone. was maintained. Group.2 had repair with Silastic Sheets only and Group 3 had Silastic Sheets repair with skin flap over the Silastic Sheets. Group 4 rabbits had Silastic Sheets in for 2~4 weeks, then was . removed and replaced with Marlex Mesh.
All rabbits except one in Group 1 succumbed within 24-72 hours from panperitonitis. The one survived has lived for 8 weeks with a huge ventral hernia. Group 2 rabbits formed a thin peritonetri like membrane, lined with a single layer of mesothelial cells, under the Silastic Sheets in 33%. Group 3 rabbits formed the new membrane in 70%. Rabbits in Group 4 developed a fairly firm thick membrane with the granulation tissue growing through the fine meshes of Marlex Mesh.
There was 75% of mortality in Group 1 and 17% in Group 2. Rabbits in Groups 3 and 4 had no mortality.
This method tried in rabbits could be applied in the clinical cases and there were three patients who had their abdominal wall defects repaired with Silastic Sheets and had good results.
The advantages of the Silastic Sheets include complete inertness and they do not adhere to body tissues, the material is easily removed following relatively long period of implantation, and it is strong enough to hold sutures and yet is pliable and can be easily trimmed to fit the defects to be repaired.

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