Chicago, Ill. From the Department of Surgery, Section of Plastic and Reconstructive Surgery, Section of Cardiac and Thoracic Surgery, Section of Cardiothoracic Surgery, University of Chicago Medical Center.
Plast Reconstr Surg. 2010 Jun;125(6):1720-1724. doi: 10.1097/PRS.0b013e3181d51292.
Postoperative mediastinitis is a serious and potentially lethal complication from cardiac surgery. Although postoperative mediastinitis cannot be reliably predicted, a number of preoperative and intraoperative risk factors have been defined by previous work. The authors now present their cumulative experience with primary sternal fixation of high-risk patients as one preventative measure.
A retrospective review from July of 2000 to October of 2006 was performed on 750 patients who had at least three established risk factors for postoperative mediastinitis and received primary titanium plate sternal fixation. Patients were followed for a minimum of 6 weeks and monitored for pain, instability, wound breakdown, and plate migration.
Rigid plate fixation was completed at the end of the primary cardiac surgical procedure in all 750 patients. Sternal dehiscence occurred in 18 patients (2.4 percent), necessitating reexploration. Four of these patients developed postoperative mediastinitis and had other significant comorbidities, such as ongoing inflammatory breast cancer or pneumonia, that were beyond the typical risk factors identified for developing mediastinitis. Successful sternal fixation was therefore accomplished in 732 patients (97.6 percent). Despite changes in instrumentation and technique, this approach was adopted by the cardiac surgical team consistently after an initial mentoring and training period by the plastic surgeons.
Primary sternal fixation is a simple and reliable method for prevention of postoperative mediastinitis development in high-risk patients. This technique, conceptualized by plastic surgeons, is now being implemented by cardiac surgeons in increasing numbers. This demonstrates the ability for plastic surgery to initiate a paradigm shift in other fields of medicine and to decrease the complications that primarily affect our practice.
心脏手术后纵隔炎是一种严重且可能致命的并发症。虽然术后纵隔炎不能可靠预测，但以前的工作已经确定了一些术前和术中的危险因素。作者现在提出他们对高危患者进行胸骨原发性固定的累积经验，作为一种预防措施。
对 2000 年 7 月至 2006 年 10 月期间的 750 例至少有 3 种术后纵隔炎确立危险因素并接受原发性钛板胸骨固定的患者进行回顾性研究。对患者进行至少 6 周的随访，监测疼痛、不稳定、伤口破裂和钢板移位。
750 例患者均在原发性心脏手术结束时完成了刚性板固定。18 例患者（2.4%）胸骨裂开，需要再次探查。其中 4 例患者发生术后纵隔炎，且有其他重大合并症，如持续的炎性乳腺癌或肺炎，这些都超出了确定纵隔炎发展的典型危险因素。因此，732 例患者（97.6%）成功进行了胸骨固定。尽管器械和技术发生了变化，但在整形外科医生进行初始指导和培训后，心脏外科团队一直采用这种方法。
原发性胸骨固定是预防高危患者术后纵隔炎发展的一种简单可靠的方法。这种由整形外科医生提出的技术，现在越来越多的被心脏外科医生所采用。这表明整形手术有能力在其他医学领域引发范式转变，并减少主要影响我们实践的并发症。
