Phan Truong Q V, Depner Christian, Theodorou Panagiotis, Lefering Rolf, Perbix Walter, Spilker Gerald, Weinand Christian
Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Burns, University Hospital Cologne-Merheim, Germany.
Ann Plast Surg. 2013 Feb;70(2):216-21. doi: 10.1097/SAP.0b013e31823b67ec.
Patients transferred to Plastic Surgery Departments for sternum osteomyelitis have a high morbidity of about 3%. Despite several known options for sternal wound coverage and salvage operations, wound dehiscence or wound necrosis can occur, increasing patient morbidity.
One hundred thirty-five patients admitted between January 2007 and December 2010 were evaluated in a retrospective study for wound dehiscence after salvage wound coverage at our institution. Various flaps were applied, such as pectoralis major myocutaneous pedicled flaps, pectoralis major muscle pedicled flaps, latissimus dorsi pedicled flaps, greater omental flaps, and vertical rectus abdominis muscle and transverse rectus abdominis muscle flaps. Inclusion criteria were sternal wound infection, bacterial wound infection, previous wound debridement outside our institution, vacuum-assisted closure device wound treatment at our institution, and secondary flap closure of the sternal defect at our institution. A multivariate regression analysis was performed.
One hundred thirty patients met the inclusion criteria. In all patients, bacterial wound colonization was shown. Forty patients showed wound dehiscence after closure at our institution. Reasons for wound dehiscence were attributed to wound size, >4 different species of bacteria colonizing the wound, gram-negative bacteria, Candida albicans, intensive care unit stay, and female gender. Interestingly, wound dehiscence was not significant correlated to obesity, smoking, atherosclerosis, renal insufficiency or type of closure influenced significantly, or necrosis.
Female patients after CABG, with large sternal wounds infected with gram-negative bacteria and candida, have an 85% risk of wound dehiscence after flap coverage for sternal wound infection.
因胸骨骨髓炎转入整形外科的患者发病率约为3%，居高不下。尽管已知有多种胸骨伤口覆盖和挽救手术的选择，但仍可能发生伤口裂开或伤口坏死，从而增加患者的发病率。
对2007年1月至2010年12月期间收治的135例患者进行回顾性研究，评估在本机构进行挽救性伤口覆盖后伤口裂开的情况。采用了多种皮瓣，如胸大肌肌皮蒂皮瓣、胸大肌肌蒂皮瓣、背阔肌蒂皮瓣、大网膜瓣以及腹直肌纵行肌瓣和腹直肌横行肌瓣。纳入标准为胸骨伤口感染、伤口细菌感染、此前在本机构外进行的伤口清创、在本机构进行的负压封闭引流装置伤口治疗以及在本机构对胸骨缺损进行的二期皮瓣闭合。进行了多因素回归分析。
130例患者符合纳入标准。所有患者均显示伤口有细菌定植。40例患者在本机构闭合伤口后出现伤口裂开。伤口裂开的原因归因于伤口大小、伤口定植细菌种类>4种、革兰氏阴性菌、白色念珠菌、入住重症监护病房以及女性性别。有趣的是，伤口裂开与肥胖、吸烟、动脉粥样硬化、肾功能不全或闭合类型、坏死无显著相关性。
冠状动脉旁路移植术后的女性患者，胸骨伤口较大且感染革兰氏阴性菌和念珠菌，在因胸骨伤口感染进行皮瓣覆盖后，有85%的伤口裂开风险。
