Third Department of Surgery, Hospital of Aviation Industry Corporation of China, Beijing, China.
Chin Med J (Engl). 2010 Oct;123(20):2803-6.
Median sternotomy is considered the most usually performed procedure in cardiac operations. This study aimed to assess clinical effectiveness of bilateral pectoralis major muscle flaps (BPMMF) for management of sternal osteomyelitis and mediastinal infection following median sternotomy.
Clinical data were collected and retrospectively analyzed from twelve patients who underwent the BPMMF transposition for management of sternal osteomyelitis and mediastinal infection following median sternotomy from January 2006 to June 2009. Procedure consisted of rigorous debridement of necrotic tissues, dead space obliteration using the BPMMF, and placement of drainage tubes connected to a negative pressures generator for adequate drainage.
No patients died of drainage, and all 12 patients had viable BPMMF when discharged from hospital. At 1 week post discharge, 2 patients presented with sternal infection but recovered following local debridement and medication. No patients showed infection recurrence during the follow-up period over 10 months.
Sternal osteomyelitis and mediastinal infection following median sternotomy may be effectively managed through rigorous debridement of infected soft tissues, resection of the damaged sternal segment, transposition of the BPMMF to fill the damaged sternum resulting from debridement, and adequate postoperative drainage.
正中开胸术被认为是心脏手术中最常进行的操作。本研究旨在评估双侧胸大肌肌皮瓣（BPMMF）在正中开胸术后胸骨骨髓炎和纵隔感染治疗中的临床效果。
回顾性分析 2006 年 1 月至 2009 年 6 月期间 12 例行 BPMMF 转位术治疗正中开胸术后胸骨骨髓炎和纵隔感染的患者的临床资料。手术包括彻底清创坏死组织，使用 BPMMF 填充死腔，放置引流管连接负压发生器以充分引流。
无患者因引流死亡，所有 12 例患者出院时均有存活的 BPMMF。出院后 1 周，2 例患者出现胸骨感染，但经局部清创和药物治疗后痊愈。随访 10 个月以上，无患者出现感染复发。
通过彻底清创感染的软组织、切除受损的胸骨段、将 BPMMF 转位填充清创后的受损胸骨，并进行充分的术后引流，可以有效地治疗正中开胸术后胸骨骨髓炎和纵隔感染。
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