Division of Cardiothoracic Surgery, Washington University, Barnes Jewish Hospital, St. Louis, Missouri 63110, USA.
Ann Thorac Surg. 2011 Jan;91(1):257-61. doi: 10.1016/j.athoracsur.2010.07.112.
This study compares conventional open debridement with the recently proposed flap closure technique for sternoclavicular joint infection.
This is a retrospective review of patients undergoing surgery for sternoclavicular joint infection during the last 7 years.
Twenty patients underwent 35 operations for sternoclavicular joint infection from 2002 to 2009. The debridement and open wound procedure (10 of 20 patients, 50%) involved debridement of the clavicle, manubrium, and first rib and open wound care. The joint resection and flap closure procedure (10 of 20 patients, 50%) involved partial resection of the clavicle, manubrium, and first rib, with immediate (9 of 10) or early (1 of 10) wound closure with pectoralis major advancement flap. The two groups were comparable in comorbidities, duration of symptoms, radiologic findings, and microbiologic results. Despite an approach of planned reoperation for wound care, the open group had fewer mean procedures performed per patient (1.6±0.7 versus 1.9±1.6), owing to fewer unplanned procedures (0 versus 0.8 procedures/patient) than the flap group. The incidence of wound complications (hematoma, seroma) was lower in open patients (0 of 10 versus 5 of 10). The median length of hospitalization was shorter in the open group (5.5 versus 10.5 days), but all open patients (10 of 10; 100%) required prolonged wound care compared with 2 of 10 (20%) in the flap group. The only hospital mortality occurred in the flap group. Eventual wound healing was satisfactory in all survivors.
For sternoclavicular joint infection, a single-stage resection and muscle advancement flap leads to a higher incidence of complications. Debridement with open wound care provides satisfactory outcomes with minimal perioperative complications but requires prolonged wound care.
本研究比较了传统的开放性清创术与最近提出的胸锁关节感染皮瓣闭合技术。
这是一项对过去 7 年中接受胸锁关节感染手术的患者进行的回顾性研究。
2002 年至 2009 年期间，20 例患者因胸锁关节感染接受了 35 次手术。清创和开放性伤口处理（20 例患者中的 10 例，50%）包括锁骨、胸骨柄和第一肋骨的清创和开放性伤口护理。关节切除和皮瓣闭合术（20 例患者中的 10 例，50%）包括锁骨、胸骨柄和第一肋骨的部分切除，9 例（10 例中的 9 例）或 1 例（10 例中的 1 例）在早期采用胸大肌推进皮瓣立即（9 例中的 9 例）或早期（1 例中的 1 例）闭合伤口。两组在合并症、症状持续时间、影像学发现和微生物学结果方面具有可比性。尽管开放性组的手术方式为计划再次手术进行伤口护理，但由于计划性再手术的次数较少（0 例与 0.8 例/患者），因此每名患者的平均手术次数较少（1.6±0.7 次与 1.9±1.6 次）。开放性组的伤口并发症（血肿、血清肿）发生率较低（0 例与 10 例）。开放性组的住院时间中位数较短（5.5 天与 10.5 天），但所有开放性患者（10 例与 10 例；100%）都需要长时间的伤口护理，而皮瓣组只有 2 例（10 例中的 2 例；20%）需要。唯一的院内死亡发生在皮瓣组。所有幸存者的最终伤口愈合情况均令人满意。
对于胸锁关节感染，一期切除和肌肉推进皮瓣会导致更高的并发症发生率。清创术加开放性伤口护理可获得令人满意的结果，且围手术期并发症较少，但需要长时间的伤口护理。
