Montandon D
Département de chirurgie, Hôpital cantonal universitaire, Genève.
Helv Chir Acta. 1991 Jul;58(1-2):95-8.
In the presence of a wound infection following a sternotomy, an active surgical treatment is currently the method of choice. Large debridement followed by an effective wound closure is advised by most authors. In our experience, most cases will respond to this treatment whateither flap is used: omentum, rectus abdominis, latissimus dorsi, pectoralis major musculocutaneous flaps. However, a few patients have had repeated attempt to close the sternal defect without success. In these cases a proper surgical treatment is a life-saving procedure. Thorough debridement and closure with bipedicled pectoralis major and rectus fascio-cutaneous flaps with drainage of the mediastinum is advised. Stabilisation of thoracic wall and filling of the dead space are not mandatory.
在胸骨切开术后出现伤口感染时，积极的手术治疗是目前的首选方法。大多数作者建议进行广泛清创，随后进行有效的伤口闭合。根据我们的经验，无论使用哪种皮瓣：大网膜、腹直肌、背阔肌、胸大肌肌皮瓣，大多数病例对这种治疗都会有反应。然而，少数患者多次尝试闭合胸骨缺损均未成功。在这些情况下，恰当的手术治疗是挽救生命的措施。建议进行彻底清创，并用双蒂胸大肌和腹直肌筋膜皮瓣闭合伤口，并对纵隔进行引流。胸廓稳定和死腔填充并非必需。
