Cabbabe Edmond B, Cabbabe Samer W
St. Louis, Mo.; and Birmingham, Ala. From St. Louis University and the Division of Plastic Surgery, University of Alabama at Birmingham.
Plast Reconstr Surg. 2009 May;123(5):1490-1494. doi: 10.1097/PRS.0b013e3181a205f9.
The management of postoperative deep sternal wound infection varies widely based on the discretion of the cardiovascular surgeon and the plastic surgeon.
Analysis of patients with deep sternal wound infection undergoing one-step radical sternal débridement and muscle flap reconstruction by a single plastic surgeon from 1986 to 2008 was conducted. Two groups of patients were identified. The immediate group was referred soon after diagnosis of sternal wound infection and without any débridement. The delayed group was referred much later after undergoing an extended management by their cardiovascular surgeon. Retrospective review was performed to compare morbidity, mortality, and length of stay between the two groups.
There were a total of 583 patients with deep sternal wound infection. Of the 497 patients referred immediately, 22 (4.4 percent) patients required mechanical ventilation for an average of 4 days, eight (1.6 percent) required tracheotomy, 13 (2.6 percent) developed stage III/IV pressure sores, 24 (4.8 percent) developed major wound dehiscence, zero (0 percent) required skin grafting, average length of stay was 4.7 days, and five died (1 percent). Of the 86 patients with a delayed referral, 40 (46.5 percent) required mechanical ventilation for an average of 18.3 days, 31 (36 percent) required tracheotomy, 20 (23.3 percent) developed stage III/IV pressure sores, 12 (14 percent) developed major wound dehiscence, nine (10.5 percent) required skin grafts, the average length of stay was 19.3 days, and four died (4.7 percent).
Patients with deep sternal wound infection following sternotomy benefit from one-step radical sternal débridement and muscle flap(s) reconstruction, as it results in a significant decrease in morbidity, mortality, and length of stay.
术后深部胸骨伤口感染的处理因心血管外科医生和整形外科医生的判断而有很大差异。
对1986年至2008年由一名整形外科医生进行一期根治性胸骨清创和肌皮瓣重建的深部胸骨伤口感染患者进行分析。确定了两组患者。即刻组在诊断出胸骨伤口感染后不久就被转诊，且未进行任何清创。延迟组在其心血管外科医生进行了长期处理后很久才被转诊。进行回顾性研究以比较两组之间的发病率、死亡率和住院时间。
共有583例深部胸骨伤口感染患者。在497例即刻转诊的患者中，22例（4.4%）需要机械通气，平均4天；8例（1.6%）需要气管切开；13例（2.6%）发生III/IV期压疮；24例（4.8%）发生严重伤口裂开；0例（0%）需要植皮；平均住院时间为4.7天；5例死亡（1%）。在86例延迟转诊的患者中，40例（46.5%）需要机械通气，平均18.3天；31例（36%）需要气管切开；20例（23.3%）发生III/IV期压疮；12例（14%）发生严重伤口裂开；9例（10.5%）需要植皮；平均住院时间为19.3天；4例死亡（4.7%）。
胸骨切开术后深部胸骨伤口感染的患者受益于一期根治性胸骨清创和肌皮瓣重建，因为这可显著降低发病率、死亡率和住院时间。
