Sansone Fabrizio, Mossetti Claudio, Bruna Maria Cristina, Oliaro Alberto, Zingarelli Edoardo, Flocco Roberto, Del Ponte Stefano, Casabona Riccardo
Division of Cardiac Surgery, Mauriziano Umberto I Hospital, Turin, Italy.
J Card Surg. 2011 Nov;26(6):600-3. doi: 10.1111/j.1540-8191.2011.01336.x. Epub 2011 Oct 12.
Wound infection is a devastating complication resulting in a high mortality rate from 7% to 80%. The risk of recurrences depends on the depth and the extension of the infection. We present our experience of omentoplasty using transomental sternal plates.
Five patients (two females, mean age 61.2 ± 8.3 years) had severe osteomyelitis requiring radical sternectomy and omental flap transposition. In three cases (60%), the sternal manubrium was completely removed: in case of upper sternectomy, chest wall stability was achieved without metallic bars; in two cases chest wall stability required the use of three metallic plates for each patient (STRATOS SYSTEM) fixed on the second, third, and fourth ribs. The plates were passed through the omental flap to obtain a partial cover of the devices.
No patient had abdominal complications. One patient had postoperative dehiscence of the superficial wound that was treated by VAC therapy for 30 days. The length of hospital stay was 65.2 ± 45.2 days. All patients had complete wound healing and are alive after 24.0 ± 21.4 months.
Omental flap transposition represents a good option in the treatment of sternal osteomyelitis. Partial or total sternal manubrium preservation and fixation are essential for the restoration of sternal stability. The use of transomental titanium plates provides chest wall stabilization when extensive sternal resection is required.
伤口感染是一种严重的并发症，死亡率高达7%至80%。复发风险取决于感染的深度和范围。我们介绍了使用经网膜胸骨板进行大网膜成形术的经验。
五名患者（两名女性，平均年龄61.2±8.3岁）患有严重骨髓炎，需要进行根治性胸骨切除术和大网膜瓣移位术。三例（60%）患者的胸骨柄被完全切除：对于上半胸骨切除术，无需金属棒即可实现胸壁稳定；两例患者的胸壁稳定需要为每位患者使用三块金属板（STRATOS系统）固定在第二、第三和第四肋骨上。金属板穿过大网膜瓣以部分覆盖这些装置。
无患者出现腹部并发症。一名患者术后浅表伤口裂开，采用负压伤口治疗（VAC）30天。住院时间为65.2±45.2天。所有患者伤口均完全愈合，在24.0±21.4个月后仍存活。
大网膜瓣移位术是治疗胸骨骨髓炎的一个好选择。部分或全部保留胸骨柄并进行固定对于恢复胸骨稳定性至关重要。当需要进行广泛的胸骨切除时，使用经网膜钛板可实现胸壁稳定。
