Losanoff Julian E, Richman Bruce W, Jones James W
Department of Surgery, M580 Health Sciences Center, University of Missouri-Columbia School of Medicine, One Hospital Drive, Columbia, MO 65212, USA.
Eur J Cardiothorac Surg. 2002 May;21(5):831-9. doi: 10.1016/s1010-7940(02)00124-0.
Disruption and infection of median sternotomy wounds are grave complications often associated with prolonged hospitalization, high cost, and significant mortality. Effective prevention techniques are still debated. Successful management requires early recognition based on a high index of suspicion, detailed physical examination, appreciation of the clinical signs and symptoms, timely imaging studies, and prompt surgical therapy. Improvements in perioperative management and critical care of patients with multisystem organ failure can reduce morbidity and mortality rates. Sternal salvage and direct sternal reclosure are possible when the infection is diagnosed early. Techniques utilizing lateral sternal support should be first-line options in the condition. Muscle flap techniques should be the next consideration when direct closure has failed or cannot be attempted.
正中胸骨切开伤口的裂开和感染是严重的并发症，常伴有住院时间延长、高成本和显著的死亡率。有效的预防技术仍存在争议。成功的处理需要基于高度怀疑指数进行早期识别、详细的体格检查、对临床体征和症状的认识、及时的影像学检查以及迅速的手术治疗。多系统器官衰竭患者围手术期管理和重症监护的改善可降低发病率和死亡率。当感染早期被诊断时，胸骨挽救和直接胸骨重新闭合是可行的。在这种情况下，采用外侧胸骨支撑的技术应作为一线选择。当直接闭合失败或无法尝试时，肌瓣技术应作为下一个考虑因素。
