Schmidt-Rohlfing B, Haas V, Vodopianov M, Kuhtin O
Klinik für Orthopädie und Unfallchirurgie, Siloah-St. Trudpert Klinkum, Wilferdinger Str. 67, 75179, Pforzheim, Deutschland,
Oper Orthop Traumatol. 2014 Jun;26(3):288-94. doi: 10.1007/s00064-013-0282-z. Epub 2014 Jun 14.
Closure of the wound defect with a pedicled pectoralis major muscular flap after successful surgical treatment of septic arthritis of the sternoclavicular joint (SCJ).
Defect of the thoracic wall after septic arthritis of the SCJ.
Persistent infection of bony or soft tissue structures; persistent septicemia; persistent mediastinitis.
After successful treatment of the local infection and radical debridement of the wound, the incision is expanded parallel to the clavicle and to the sternum. The neurovascular pedicled pectoralis flap is mobilized and a resection of the muscular attachment at the humerus is performed. Finally, the flap is rotated at the pedicle and attached to the defect zone.
Anticoagulation with low molecular weight heparin and possibly aspirin (100 mg/day); short-term immobilization of the involved upper extremity. Avoidance of major weight bearing for a period of 6 weeks.
Over a period of 4 years, 18 patients suffering from septic arthritis of the SCJ underwent surgical treatment. Of these, 9 patients were treated with pedicled muscular flap. In all patients, uneventful wound healing was observed with no further revision operations being required. The functional and optical results were satisfactory.
在成功手术治疗胸锁关节（SCJ）化脓性关节炎后，用带蒂胸大肌肌瓣封闭伤口缺损。
SCJ化脓性关节炎后胸壁缺损。
骨或软组织结构持续感染；持续性败血症；持续性纵隔炎。
在成功治疗局部感染并对伤口进行彻底清创后，沿锁骨和胸骨平行方向扩大切口。游离带神经血管蒂的胸肌瓣，并在肱骨处切除肌肉附着点。最后，将肌瓣绕蒂旋转并附着于缺损区。
用低分子量肝素抗凝，可能加用阿司匹林（100毫克/天）；短期固定受累上肢。6周内避免负重。
在4年期间，18例SCJ化脓性关节炎患者接受了手术治疗。其中，9例患者采用带蒂肌瓣治疗。所有患者伤口均顺利愈合，无需进一步翻修手术。功能和外观结果令人满意。
