Vural A Hakan, Yalçinkaya Serhat, Türk Tamer, Oztürk Alpaslan, Sezen Mustafa, Yavuz Senol, Ozyazicioglu Ahmet
Department of Cardiovascular Surgery, Bursa Yüksek Ihtisas Education and Research Hospital, Bursa, Turkey.
Heart Surg Forum. 2007;10(5):E397-400. doi: 10.1532/HSF98.20071089.
When a sternotomy cannot be performed at the midline and/or there is infection at the operation site, sternotomy revision can cause problems that increase the mortality and morbidity of the patients. There is no agreement on the best treatment method. In this paper we present a modified wiring technique.
This technique consisted of wrapping wires twice around each rib head and placing standard circumferential wire sutures, thus providing full stability by decreasing the load on the sternum using only steel wires. The study group included 23 patients with sternal dehiscence because of inappropriate sternotomy (n = 10) and/or mediastinitis (n = 13). Two mediastinal tubes were placed for irrigation in 13 patients with mediastinitis and/or wound infection, and mobilization and interposition of omentum as an axial graft was performed in 2 patients. Irrigation and antibiotherapy were continued for 4 to 6 weeks.
Complete wound healing was obtained in all patients. Twenty-two patients treated with this technique survived. One patient died on postoperative 42nd day because of renal insufficiency and multi-organ failure.
Early and aggressive debridement of infected and necrotic tissue, irrigation, and antibiotics are necessary for successful treatment, but we believe that the most important factor is full stabilization of the sternal tissue with minimal use of foreign stabilization material. Despite the limited number of cases, we suggest that our stabilization technique seems to be successful in achieving full stabilization even in infected and fragile sternal bony tissue in patients with sternal dehiscence and/or inappropriate sternotomy.
当无法在胸骨中线进行胸骨切开术和/或手术部位存在感染时，胸骨切开术的翻修可能会引发一些问题，从而增加患者的死亡率和发病率。目前对于最佳治疗方法尚无定论。在本文中，我们介绍一种改良的钢丝固定技术。
该技术包括在每个肋骨头周围将钢丝缠绕两次，并放置标准的环形钢丝缝线，通过仅使用钢丝减轻胸骨上的负荷，从而提供充分的稳定性。研究组包括23例因胸骨切开术不当（n = 10）和/或纵隔炎（n = 13）导致胸骨裂开的患者。13例患有纵隔炎和/或伤口感染的患者放置了两根纵隔引流管用于冲洗，2例患者进行了大网膜的游离和带蒂移植。冲洗和抗生素治疗持续4至6周。
所有患者伤口均完全愈合。采用该技术治疗的22例患者存活。1例患者在术后第42天因肾功能不全和多器官衰竭死亡。
对于成功治疗而言，早期积极清除感染和坏死组织、冲洗以及使用抗生素是必要的，但我们认为最重要的因素是以最少使用外部固定材料来充分稳定胸骨组织。尽管病例数量有限，但我们认为我们的固定技术似乎能够成功实现充分稳定，即使是对于胸骨裂开和/或胸骨切开术不当患者中感染且脆弱的胸骨骨质组织。
