Colak Abdurrahim, Kaya Ugur, Ceviz Münacettin, Becit Necip, Sevil Fehimcan, Kocak Hikmet
Department of Cardiovascular Surgery, Ataturk University, Erzurum, Turkey.
Heart Surg Forum. 2016 Dec 1;19(6):E265-E268. doi: 10.1532/hsf.1511.
Mediastinal infection is one of the most serious complications that occurs following open-heart surgery by sternotomy. In the present study, omentoplasty was initially and aggressively used to treat the infection and prevent the recurrence caused by bones in cases of mediastinitis following open-heart surgery at our clinic.
Among the 3656 patients who underwent surgery at our department of cardiovascular surgery between January 1996 and December 2012, omentoplasty as a treatment for mediastinitis was applied to 19 (0.51%) patients (of which 13 were males) following sternotomy. The cases were revised on the 15th day following the first surgery and/or when there was a suspicion of mediastinal infection. The necrotic skin, subcutaneous tissue, and bone tissue were resected, and all the affected sternal tissues were removed until healthy hemorrhagic areas were reached.
The average age of the patients was between 49 and 81 years (mean: 65.7 ± 10.5 years). The mean age of the men was 66.08 ± 12.7 years (age range: 49-81 years) and that of the women was 63.2 ± 6.8 years (age range: 55-71 years). The male to female ratio was 2:1, and in both the male and female groups, the approximate age ranged from 55 and 70 years. In the intraoperative cultures received from wound cases, the most common agent of infection was methicillin-resistant coagulase-negative staphylococci. Purulent leaks from eight patients stopped in approximately 4 days. Purulent leaks from the other 11 patients continued until the 6th day, and thus, medical dressing also continued, after which the leaks stopped on the 15th day. The approximate postoperative hospital stay was 32 days (range: 13-63 days).
Omentoplasty in heart surgery can be considered an effective method when used to control infection and treat secondary poststernotomy mediastinitis.
纵隔感染是胸骨切开术式心脏直视手术后最严重的并发症之一。在本研究中，我院对心脏直视手术后纵隔炎病例首次积极采用大网膜移植术治疗感染并预防骨质所致的复发。
1996年1月至2012年12月在我院心血管外科接受手术的3656例患者中，19例（0.51%）患者（其中男性13例）在胸骨切开术后接受大网膜移植术治疗纵隔炎。病例于首次手术后第15天和/或怀疑有纵隔感染时进行修正。切除坏死的皮肤、皮下组织和骨组织，切除所有受累的胸骨组织，直至达到健康的出血区域。
患者平均年龄在49至81岁之间（平均：65.7±10.5岁）。男性平均年龄为66.08±12.7岁（年龄范围：49 - 81岁），女性平均年龄为63.2±6.8岁（年龄范围：55 - 71岁）。男女比例为2:1，男性和女性组的大致年龄范围均为55至70岁。在伤口病例的术中培养中，最常见的感染病原体是耐甲氧西林凝固酶阴性葡萄球菌。8例患者的脓性渗漏在约4天内停止。其他11例患者的脓性渗漏持续至第6天，因此继续进行换药，之后渗漏在第15天停止。术后平均住院时间约为32天（范围：13 - 63天）。
心脏手术中的大网膜移植术在用于控制感染和治疗胸骨切开术后继发性纵隔炎时可被视为一种有效的方法。
