Weinand Christian, Xu Weiguo, Perbix Walter, Theodorou Panagiotis, Lefering Rolf, Spilker Gerald
Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Burns.
J Plast Surg Hand Surg. 2013 Oct;47(5):355-62. doi: 10.3109/2000656X.2013.769441. Epub 2013 May 28.
Patients with sternum osteomyelitis are transferred to plastic surgery departments for wound coverage. Several options of flap coverage are known; however, various wound diameters need different flaps. In a retrospective study, 135 patients from 2006-2010 with deep sternal wound infections were evaluated. From 2006-2009 various flaps were used for wound coverage, as described in published reports. In 2010 a developed algorithm was used for defect coverage based on wound width using pectoralis muscle flaps or the latissimus dorsi muscle flap. Two groups of patients were analyzed, from 2006-2009 and 2010, and in a matched pair analysis patients with small wound width less than 6 cm, medium wounds widths between 6-12 cm, and large wound width larger than 12 cm. End-point was wound dehiscence larger than 1 cm. Statistical analysis was done by Mann Whitney U-test using the SPSS program. Forty-eight patients were included in the match from a total of 130 study patients. Statistical analysis did not show significant difference in patient population of the two groups. In the group with wound sizes less than 6 cm a significant difference was found when using the algorithm. In the other groups no statistically significant difference was seen; however lesser numbers in wound dehiscence were found. In addition, a significantly lesser length of stay was found in the ICU and length of the hospital stay for all groups treated according to the algorithm. A reduction of costs may be achieved when using the algorithm based on wound size.
患有胸骨骨髓炎的患者被转至整形外科进行伤口覆盖。已知有几种皮瓣覆盖的选择；然而，不同的伤口直径需要不同的皮瓣。在一项回顾性研究中，对2006年至2010年的135例深部胸骨伤口感染患者进行了评估。2006年至2009年，如已发表报告中所述，使用了各种皮瓣进行伤口覆盖。2010年，采用一种基于伤口宽度的算法，使用胸大肌皮瓣或背阔肌皮瓣进行缺损覆盖。分析了两组患者，即2006年至2009年组和2010年组，并在配对分析中纳入了伤口宽度小于6 cm的小伤口患者、伤口宽度在6 - 12 cm之间的中等伤口患者以及伤口宽度大于12 cm的大伤口患者。终点指标为伤口裂开大于1 cm。使用SPSS程序通过曼-惠特尼U检验进行统计分析。在总共130例研究患者中，48例患者被纳入配对。统计分析未显示两组患者群体有显著差异。在伤口尺寸小于6 cm的组中，使用该算法时发现有显著差异。在其他组中未观察到统计学上的显著差异；然而，伤口裂开的数量较少。此外，对于所有按照该算法治疗的组，在重症监护病房的住院时间和住院总时长均显著缩短。基于伤口尺寸使用该算法可能会降低成本。
