[Feasibility study on repairing full-thickness abdominal wall defect with pedicled demucosal small intestinal sheet]

To overcome the disadvantages of the artificial materials, to design pedicled demucosal small intestinal sheet to repair full-thickness abdominal wall defect.

The porcine model of full-thickness abdominal wall defect by resecting 10 cm x 7 cm abdominal wall tissue (from skin to peritoneum) in 20 female animals, which were randomized to jejunum and ileum sheet groups(n = 10). Defect of abdominal wall were repaired with pedicled demucosal jejunum/ileum sheet respectively and immediate split-thickness free skin grafting. The general condition was observed and the tension strength of the repaired abdominal wall was measured 30 days postoperatively. In another 5 models, defect was repaired with pedicled demucosal small intestinal sheets and immediate split-thickness free skin grafting. The histological change and tissue thickness of the pedicled demucosal small intestinal sheet, split-thickness free skin graft and the repaired abdominal wall were observed and measured respectively after 30 days of operation.

The operations were successful and no operative death occurred in all animals. All pedicled demucosal small intestinal sheets primarily healed to the edge of defected abdominal walls. Neither infection nor wound dehiscence occurred. All the split-thickness free skin grafting were successful. Regeneration of the intestinal mucosa occurred 4 days to 5 days postoperatively in 3 animals (2 of jejunum sheet group and 1 of ileum sheet group) at the initial stage and were successfully treated. No postoperative herniation occurred in all animals. The celiac pressure of herniation of the repaired abdominal wall jejunum/ileum sheet was (24.8 +/- 3.4) kPa in jejunum sheet group and (21.3 +/- 2.8) kPa in ileum sheet group, and the difference was significant (P < 0.01). No rupture of the repaired abdominal wall occurred in jejunum and ileum sheet groups when the cel iac pressure was 40 kPa. Before repairing the abdominal wall defects, there was a little residual mucosal tissue on the surface of all pedicled demucosal small intestinal sheets. At the 30th day after operation, conspicuous hyperplasia and thickening occurred in all parts of tissue of the repaired abdominal walls and the residual mucosal tissue disappeared completely.

Because of simple operation, satisfactory achievement ratio, good effect, no important complication, and no use of expensive prosthetic materials, it is a feasible method to repair the full-thickness abdominal wall defect with pedicled demucosal small intestinal sheet.