Abstract: Objective:To investigate the clinical efficacy of allogeneic cross linked dermal dressing (ACLD) for the treatment of enteroatmospheric fistula (EAF) in patients with open abdomen (OA).
Methods:The clinical data of 44 patients with experienced trauma who received OA at Nanjing General Hospital of Nanjing Military Command from January 2011 to January 2014 were retrospectively analyzed. All patients received temporary abdominal closure (TAC) by modified sandwich vacuum package (MSVP). From January 2011 to December 2012, 33 patients with OA received vaseline gauze as abdominal cover layer ( VG group), and from January 2013 to January 2014, 11 patients with OA received allogeneic cross linked dermal dressing as abdominal cover layer (ACLD group).Patients were followed up via outpatient examination or telephone interview till October 2014.
The incidence of EAF, time for skin grafting, hematologic indexes in 2 weeks after surgery (white blood cell counts, percentage of neutrophil, the mean value of procalcitonin and C reactive protein), the duration of post operative hospital stay, hospital expenses and survival rates in the 2 groups were analyzed using t test, repeated measures analysis of variance and Fisher′s exact test.
Results:The incidence of EAF in the VG group and ACLD group was 42.4%(14/33) and 0, respectively, with a significant difference between the 2 groups (P<0.05). The duration of skin grafting was (15±6)days in the VG group and (11±3)days in the ACLD group, with a significant difference between the 2 groups (t=2.10, P<0.05). The mean values of preoperative procalcitonin and postoperative procalcitonin at day 1, 3, 7, 14 in the VG group were (1.20±0.60)μg/L and (2.50±0.90)μg/L, (1.70±0.30)μg/L, (1.90±0.40)μg/L and (2.70±0.60)μg/L, which were significantly higher than that of (0.90±0.30)μg/L and (1.80±0.60)μg/L, (1.30±0.50)μg/L, (0.60±0.20)μg/L and (0.30±0.07)μg/L in the ACLD group (F=8.50, P<0.05). The white blood cell counts and percentage of neutrophil and the percentage of C reactive protein between the 2 groups were changed from (13.8±2.4)×109/L, (12.9±2.1)×109/L, 0.90±0.09, 0.88±0.06, (81±19)mg/L, (136±28)mg/L to (16.2±3.3)×109/L, (7.9±3.0)×109/L, 0.85±0.12, 0.79±0.09, (131±30)mg/L, (59±22)mg/L at postoperative day 14, showing no significant difference between the 2 groups (F=3.10, 0.50, 1.20, P>0.05). Duration of hospital stay and hospital expenses in the VG group and ACLD group were (137±32)days, (638 831±113 670)yuan and (82±44)days, (474 839±78 543)yuan, respectively, with a significant difference between the 2 groups (t=3.60, 4.43, P<0.05). The time of follow up and overall survival rate in the VG group and ACLD group were 29 to 38 months and 81.8%(27/33), and 10 to 20 months and 90.9%(10/11), respectively, with no significant difference (P>0.05).
Conclusion:Allogeneic cross linked dermal dressing as abdominal cover layer can effectively decrease EAF in patients with open abdomen.