Ahumada Leonik A, de la Torre Jorge I, Ray Peter D, Espinosa-de-Los-Monteros Antonio, Long James N, Grant John H, Gardner Paul M, Fix R Jobe, Vásconez Luis O
University of Alabama at Birmingham, Division of Plastic Surgery, Birmingham, AL 35294-3411, USA.
Ann Plast Surg. 2005 Mar;54(3):264-8; discussion 267.
The predisposing risk factors for sternal wound infection have been well delineated. However, the indications and comorbidity of patients who require cardiac surgery via the median sternotomy approach have changed over time and subsequently have changed the patient population presenting with sternal wound complications. These trends in cardiac surgery may require an adjustment of the plastic surgical approach and methods to optimize outcomes in the patient population.
A retrospective review was performed to identify patients who had undergone sternectomy or sternal debridement followed by flap coverage. A total of 93 cases performed between 1999 and 2004 examined to collect data about the initial presentation, operative procedure, and postoperative care of each patient. The data were then analyzed to identify population characteristics using logistic regression variables to determine univariate and adjusted (multivariable) measures of association with mortality.
Results of the review indicated that 53% of the patients were male and 47% were female, with a median age of 62 years. Preoperative comorbidities included 64% of the patients were over age 60, 43% had diabetes, 51% had hypertension, 13% had renal insufficiency, and 6% were transplant recipients. The method of reconstruction varied, but the majority were pectoralis advancement flaps. Of the patients who underwent debridement and reconstruction, there was a 16% 30-day mortality. Among these mortalities, the distribution was 33% (5/15) male and 66% (10/15) female.
Though the incidence of sternal wound problems is rare (about 1%-5%), there is a significant population of older, renal-insufficient, malnourished patients who present days or weeks after one would normally diagnose and treat a deep sternal wound infection who have a significant mortality rate. Appropriate identification of risk factors, preoperative management and timing for aggressive surgical treatment is required to maximize successful outcomes in this problematic patient population.
胸骨伤口感染的诱发风险因素已得到明确界定。然而，采用正中胸骨切开术进行心脏手术的患者的适应症和合并症随时间发生了变化，进而改变了出现胸骨伤口并发症的患者群体。心脏手术的这些趋势可能需要调整整形外科的手术方法，以优化该患者群体的治疗效果。
进行了一项回顾性研究，以确定接受胸骨切除术或胸骨清创术并随后采用皮瓣覆盖的患者。对1999年至2004年间进行的93例病例进行了检查，以收集每位患者的初始表现、手术过程和术后护理的数据。然后对数据进行分析，使用逻辑回归变量确定人群特征，以确定与死亡率相关的单变量和校正（多变量）关联度量。
回顾结果表明，53%的患者为男性，47%为女性，中位年龄为62岁。术前合并症包括64%的患者年龄超过60岁，43%患有糖尿病，51%患有高血压，13%患有肾功能不全，6%为移植受者。重建方法各不相同，但大多数是胸大肌推进皮瓣。在接受清创和重建的患者中，30天死亡率为16%。在这些死亡病例中，男性占33%（5/15），女性占66%（10/15）。
尽管胸骨伤口问题的发生率很低（约1%-5%），但有相当一部分年龄较大、肾功能不全、营养不良的患者在通常诊断和治疗深部胸骨伤口感染数天或数周后才出现，他们的死亡率很高。需要正确识别风险因素、进行术前管理并确定积极手术治疗的时机，以在这一有问题的患者群体中实现最大的成功治疗效果。
