Department of Surgery, Kuopio University Central Hospital, Kuopio, Finland.
Scand J Surg. 2013;102(1):3-8. doi: 10.1177/145749691310200102.
Infection of sternotomy wound is a rare potentially fatal complication because of the risk for deep sternal infection. Current treatment comprises antibiotics, debridement, negative pressure wound therapy and sometimes transposition of muscle or omental flaps to fill the anterior mediastinal dead space.
The management of 60 consecutive deep sternotomy wound infections is reviewed. The one stage treatment was mostly chosen. In 5 patients after debridement, negative pressure wound therapy was used before flap reconstruction. Fifty-seven patients were rewired and 3 patients had sternectomy. The choice of the flap was based mainly on anatomic location of a sternal wound defect and also on which grafts been used in cardiac operation.
The unilateral turnover split pectoralis major flap was the choice for 50 patients. In 8 patients latissimus dorsi flap was used. Rectus abdominis was used as a standalone flap in 4 patients and in combination with pectoralis major in one. All patients survived after deep sternal wound infection. In only 33 patients the recovery was totally uneventful. In the remaining 27 patients there were one or more complications. Not a single flap was lost completely, but due to partial flap necrosis, a redo reconstruction was needed in 3 patients. Negative pressure wound therapy was used after flap reconstruction in eight patients with incomplete post-flap healing to prepare for wound revision and split thickness skin graft.
A structured approach including both cardiac and plastic surgery in case of deep sternal wound infection is recommended. A single stage surgery with the help of muscle flap reconstruction is our standard treatment. With our protocol, we have been able to keep the mortality low.
胸骨切开术后感染是一种罕见的潜在致命并发症，因为存在深部胸骨感染的风险。目前的治疗包括抗生素、清创、负压伤口治疗，有时还需要进行肌肉或网膜瓣转移以填充前纵隔死腔。
回顾了 60 例连续的深部胸骨切开伤口感染的治疗情况。主要选择了一期治疗。在 5 例清创后，在皮瓣重建前使用了负压伤口治疗。57 例患者重新固定胸骨，3 例患者进行了胸骨切除术。皮瓣的选择主要基于胸骨伤口缺损的解剖位置，以及心脏手术中使用的移植物。
50 例患者选择了单侧翻转胸大肌皮瓣，8 例患者选择了背阔肌皮瓣，4 例患者单独使用了腹直肌皮瓣，1 例患者与胸大肌联合使用。所有患者在深部胸骨切开伤口感染后存活。仅有 33 例患者完全无并发症。在其余 27 例患者中，出现了 1 个或多个并发症。没有一个皮瓣完全丢失，但由于部分皮瓣坏死，有 3 例患者需要进行再次重建。在 8 例皮瓣愈合不完全的患者中，使用负压伤口治疗以准备进行伤口修复和中厚皮片移植。
推荐在深部胸骨切开伤口感染时采用心脏外科和整形外科联合的结构化方法。在肌肉皮瓣重建的帮助下进行一期手术是我们的标准治疗方法。通过我们的方案，我们能够保持低死亡率。
