中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

肌瓣成形新技术治疗胸骨切口深部感染 23 例

查看全文

目的 探讨胸大肌瓣翻转、伤口内无异物存留技术成形治疗胸骨切口深部感染的安全性与有效性。 方法 纳入我院2016 年 6~12 月胸骨切口深部感染患者 23 例,男 13 例、女 10 例,年龄 4~73(54.5±19.5)岁。8 例合并糖尿病,1 例合并慢性阻塞性肺疾病和脑梗塞。分型:Ⅱ 型 18 例,Ⅲ 型 5 例;5 例纵隔残存脓腔。彻底清创伤口后,采用肌瓣成形新技术治疗胸骨切口感染:游离胸大肌将其外侧切断制备成肌瓣,向内翻转填充于胸骨缺损处,用减张缝合法将肌瓣填充并固定,切口全层缝合皮下皮肤。 结果 胸骨清创后胸骨缺损成形使用双侧胸大肌瓣 17 例、单侧 6 例,切口 Ⅰ 期愈合 21 例(91.3%),切口皮肤延迟愈合 2 例,均自行愈合。胸廓无反常呼吸 22 例,因合并症致多器官衰竭死亡 1 例。平均住院时间 10.6 d。术后 1 个月胸部 CT 检查切口愈合良好。术后随访5.9(3~9)个月,患者未诉不适。 结论 胸大肌瓣翻转、伤口内无异物存留技术成形治疗胸骨切口深部感染技术独特, 有 Ⅰ 期愈合率高、并发症少、住院时间短的优势。

Objective To study the effect of deep sternal wound infections(DSWIs)treated by the techniques of pectoral major muscular(PM) turnover and non-suture remain after the wound restitution. Method We retrospectively analyzed the clinical data of 23 patients with DSWIs in our hospital between June 2016 and December 2016. There were 13 males and 10 females at age of 4-73(54.5±19.5) years. There were 8 patients with concomitant diabetes mellitus and 1 patient with chronic obstructive pulmonary disease(COPD) and brain infarction. Eigteen patients were of type Ⅱ, 5 patients of type Ⅲ according to Pairolero’ classification in the DSWIs. Five patients were with remaining abscess cavity in the mediastinum by thoracic compute tomography(CT). Under general anesthesia the DSWIs debrided thoroughly. The PM elevated from the anterior pectoralis major fascia off subcutaneous tissue to lateral to anterior axillary line, the PM cutted off, then made to the muscle flap, turnover PM flap filled and fixed to sternal wound by lighten tensile suture, the subcutaneous tissue and skin sutured by cutting full-thickness. Results The sternal reconstruction after debridement of the sternal wound was used by bilateral PM flap in the 17 patients, unilateral PM in 6 patients. There were 21(91.3%) patients in stage Ⅰ healing, 2 patients deferment healing of local cut skin without reoperation. There were 22 patients with non-paradoxical breathing during the postoperation. One death resulted from multiple-organ failure of the concomitant disease. The average of hospital day was 10.6 days. The wound healing was good by chest CT at 1 month after the operation. Conclusion The sternal forming by the technique of the PM flap turnover, without remain of fremde stoffe in wound for DSWIs is distinctive method, evident effect.

关键词: 胸骨切口深部感染; 肌瓣成形; 外科治疗; 胸廓重建

Key words: Deep sternal wound infections; pectoralis major muscle flap; surgery; thoracic reconstruction

引用本文: 刘吉福, 高永顺, 李宝成, 许笑彬, 黄铄. 肌瓣成形新技术治疗胸骨切口深部感染 23 例. 中国胸心血管外科临床杂志, 2018, 25(4): 321-324. doi: 10.7507/1007-4848.201703045 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Rupprecht L, Schmid C. Deep sternal wound complications: An overview of old and new therapeutic options. Open J Cardiovasc Surg, 2013, 6(10): 9-19.
2. Mangram AJ, Horan TC, Pearson ML, et al. Guideline for prevention of surgical site infection, 1999, Centers for Disease Control and Prevention(CDC)Hospital Control Practices Advisory Committee. Am J Infect Control, 1999, 27(2): 97-132.
3. Cayci C, Russ M, Cheema FH, et al. Risk analysis of deep sternal wound infections and their impact on long-term survival: a propensity analysis. Ann Plast Surg, 2008, 61(3): 294-301.
4. Yumun G, Erdolu B, Toktas F, et al. Deep sternal wound infection after coronary artery bypass surgery: management and risk factor analysis for mortality. Heart Surg Forum, 2014, 17(4): E212-E216.
5. Singh K, Anderson E, Harper JG. Overview and management of sternal wound infection. Semin Plast Surg, 2011, 25(1): 25-33.
6. Deniz H, Gokaslan G, Arslanoglu Y, et al. Treatment outcomes of postoperative mediastinitis in cardiac surgery; negative pressure wound therapy versus conventional treatment. J Cardiothorac Surg, 2012, 7(1): 67-74.
7. Gdalevitch P, Afilalo J, Lee C. Predictors of vacuum-assisted closure failure of sternotomy wounds. J Plast Reconstr Aesthet Surg, 2010, 63(1): 180-183.
8. van Wingerden JJ, Tubbik D, van der Horst CM, et al. Poststernotomy mediastinitis: a classification to initiate and evaluate reconstructive management based on evidence from a structured review. J Cardiothorac Surg, 2014, 19(1): 179-188.
9. Pairolero PC, Arnold PG. Management of recalcitrant median sternotomy wounds. J Thorac Cardiovasc Surg, 1984, 88(3): 357-364.
10. Jang YJ, Park MC, Park DH, et al. Immediate debridement and reconstruction with a pectoralis major muscle flap for poststernotomy mediastinitis. Arch Plast Surg, 2012, 39(1): 36-41.
11. van Wingerden JJ, Lapids O, Boonstrab PW, et al. Muscle flaps or omental flap in the management of deep sternal wound infection. Interact Cardiovasc Thorac Surg, 2011, 13(2): 179-187.
12. Bagheri R, Tashnizi MA, Haghi SZ, et al. Therapeutic outcomes of pectoralis major muscle turnover flap in mediastinitis. Korean J Thorac Cardiovasc Surg, 2015, 48(4): 258-264.
13. 孙广龙, 曹向戌, 张健群. 双侧胸大肌内侧头转移术治疗心脏胸骨哆开. 中国胸心血管外科临床杂志, 2013, 20(2): 185-187.
14. Ennker IC, Ennker JC. Management of sterno-mediastinitis. HSR Proc Intens Care Cardiovasc Anesth, 2012, 4(4): 233-241.
15. Diez C, Koch D, Kuss O, et al. Risk factors for mediastinitis after cardiac surgery—a retrospective analysis of 1700 patients. J Cardiothorac Surg, 2007, 2(1): 23-31.