Fernández-Palacios J, Abad C, García-Duque O, Baeta P
Department of Plastic Surgery, University Hospital of Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain.
J Cardiovasc Surg (Torino). 2010 Oct;51(5):765-71.
the treatment of mediastinitis, after median sternotomy, in open heart surgery operated patients, remains an important and challenging problem in cardiac surgery. The management of this severe complication by means of surgical debridement of the sternum followed by mediastinal closure with pectoralis major muscle flaps, represents one of the best effective and most common modalities of treatment. The aim of the present publication is to demonstrate the good and comparable result in the mediastinal closure by using a single pectoralis muscle flap instead of two pectoralis muscle flaps.
in our hospital, between July 1998 and December 2004, 32 patients with mediastinitis were treated after adult open heart surgery with sternal debridement and pectoralis major muscle flaps. In 19 cases the sternal closure was performed with a single pectoralis muscle (group U) and in 13 cases with both pectoralis muscles (Group B).
comparing the group U and group B, we did not found statistical differences in the variables of age, sex, associated diseases, previous myocardial infarction, kind of cardiac surgery undertaken, quality of the sternum, type of germen, number of previous sternal debridement performed and time of hospitalization. Patients in group U showed a statistically significant (P=0.001) shorted plastic reconstructive surgery time, an earlier extubation time (non statistically significant) and less need of blood transfusion (non statistically significant). The morbidity and hospital mortality in group U and B did not show any statistical differences. There were three cases of flap related complications in group B and two in group U. One death was recorded in group U (7.69%) and another in group B (5.26%).
mediastinal infection after cardiac surgery can be effectively managed by surgical debridement followed by plastic coverage with a single pectoralis muscle flap. In our experience, this unilateral pectoralis muscle flap technique showed similar results to the classic closure with both pectoralis muscle flaps. The unilateral technique represents a relative low aggressive operation and preserves intact the contralateral pectoralis muscle. Comparing the single pectoralis muscle flap technique with the bilateral pectoralis musle technique, the former is faster, the extubation is earlier and there is less need of postoperative blood transfusions.
在接受心脏直视手术的患者中，正中开胸术后纵隔炎的治疗仍是心脏外科领域一个重要且具有挑战性的问题。通过胸骨清创术，随后采用胸大肌瓣进行纵隔闭合来处理这种严重并发症，是最有效且最常用的治疗方式之一。本出版物的目的是证明使用单块胸大肌瓣而非两块胸大肌瓣进行纵隔闭合能取得良好且相当的效果。
1998年7月至2004年12月期间，我院对32例心脏直视手术后发生纵隔炎的患者进行了胸骨清创术及胸大肌瓣治疗。其中19例采用单块胸大肌进行胸骨闭合（U组），13例采用两块胸大肌进行胸骨闭合（B组）。
比较U组和B组，在年龄、性别、相关疾病、既往心肌梗死、所进行的心脏手术类型、胸骨质量、病菌类型、既往胸骨清创次数及住院时间等变量方面未发现统计学差异。U组患者的整形重建手术时间显著缩短（P = 0.001），拔管时间更早（无统计学意义），输血需求更少（无统计学意义）。U组和B组的发病率及医院死亡率未显示出任何统计学差异。B组有3例与皮瓣相关的并发症，U组有2例。U组记录到1例死亡（7.69%），B组记录到1例死亡（5.26%）。
心脏手术后的纵隔感染可通过手术清创，随后采用单块胸大肌瓣进行整形覆盖来有效处理。根据我们的经验，这种单侧胸大肌瓣技术与经典的双侧胸大肌瓣闭合术效果相似。单侧技术是一种相对侵袭性较低的手术，对侧胸大肌保持完整。将单块胸大肌瓣技术与双侧胸大肌瓣技术相比较，前者速度更快，拔管更早，术后输血需求更少。
