Poncelet Alain Jean, Lengele Benoit, Delaere Bénédicte, Zech Francis, Glineur David, Funken Jean-Christophe, El Khoury Gebrine, Noirhomme Philippe
Department of Cardio-Vascular and Thoracic Surgery, Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Belgium.
Eur J Cardiothorac Surg. 2008 Feb;33(2):232-8. doi: 10.1016/j.ejcts.2007.11.016. Epub 2007 Dec 21.
To evaluate a simple treatment algorithm in sternal wound infection (SWI) allowing for primary closure and to describe the different surgical techniques and their associated morbidity and mortality.
A retrospective analysis of all patients operated on between 1996 and 2004 in a single tertiary care institution. All epidemiological and surgical data were prospectively collected in our database. Univariate and multivariate analysis were used to determine preoperative and perioperative risks factors for 90-day and long-term mortality.
Out of 5905 procedures, 146 sternal wound infections were documented (2.4%). The respective incidence of SWI for CABG, isolated valve, or combined procedures were 2.8%, 1.1%, and 3.2%. Pathogens involved were S. epidermidis (44.5%), S. aureus (31.5%), and gram-negative rods (19.2%). Re-operation was required in 131/146 patients. Mean time to the first re-operation was 17.3+/-12 days. Modalities of treatment consisted of drainage alone (44 patients), rewiring (25 patients), debridement, rewiring and mediastinal lavage (52 patients), and partial/complete sternal resection (10 patients). Additional procedures were required in 49 patients (37.7%). The 90-day mortality for uninfected patients and patients with superficial SWI were 4.4% and 2.8% (p=0.78) whereas for patients with deep SWI, 90-day mortality was 14.5% (DSWI vs others, p<0.0001).
Deep sternal wound infection (DSWI) remains a dreadful complication in contemporary cardiac surgery while risk factors are currently well defined. Using a simple approach of primary closure together with liberal use of vascularized flaps has allowed us to achieve satisfactory short-term outcome in this subset of patients.
评估一种用于胸骨伤口感染（SWI）的简单治疗方案，该方案允许一期缝合，并描述不同的手术技术及其相关的发病率和死亡率。
对1996年至2004年在一家三级医疗机构接受手术的所有患者进行回顾性分析。所有流行病学和手术数据均前瞻性地收集于我们的数据库中。采用单因素和多因素分析来确定90天和长期死亡率的术前和围手术期风险因素。
在5905例手术中，记录到146例胸骨伤口感染（2.4%）。冠状动脉旁路移植术（CABG）、单纯瓣膜手术或联合手术的SWI发生率分别为2.8%、1.1%和3.2%。涉及的病原体为表皮葡萄球菌（44.5%）、金黄色葡萄球菌（31.5%）和革兰氏阴性杆菌（19.2%）。146例患者中有131例需要再次手术。首次再次手术的平均时间为17.3±12天。治疗方式包括单纯引流（44例患者）、重新布线（'25例患者）、清创、重新布线和纵隔灌洗（52例患者）以及部分/完全胸骨切除（10例患者）。49例患者（37.7%）需要额外的手术。未感染患者和浅表SWI患者的90天死亡率分别为4.4%和2.8%（p = 0.78），而深部SWI患者的90天死亡率为14.5%（深部胸骨伤口感染与其他情况相比，p < 0.0001）。
深部胸骨伤口感染（DSWI）在当代心脏手术中仍然是一种可怕的并发症，而目前风险因素已明确界定。采用一期缝合的简单方法并广泛使用带血管蒂皮瓣，使我们在这部分患者中取得了满意的短期结果。
