Kubat Emre, Abacı Malik, Ünal Celal Selçuk
Department of Cardiovascular Surgery, Gülhane Training and Research Hospital, General Dr. Tevfik Sağlam Cd. No: 1, Etlik, 06010, Ankara, Turkey.
Department of Plastic, Reconstructive and Aesthetic Surgery, Karabük Training and Research Hospital, Karabük, Turkey.
Gen Thorac Cardiovasc Surg. 2019 Jun;67(6):518-523. doi: 10.1007/s11748-018-1052-5. Epub 2018 Dec 19.
Sternal wound infections after sternotomy are associated with high morbidity, high mortality, and prolonged hospital stay. The recurrence rate of sternal wound infections after single-stage closure is greater than expected. The aim of the study is to present our results of a consecutive series of Z-plasty for the treatment of recurrent sternal wound infections.
Between March 2015 and March 2017, a total of 9 patients were referred to our clinic with a recurrent sternal wound infection due to sternotomy with or without osteomyelitis. All patients previously underwent one or more surgical procedures for sternal infection. Negative pressure wound therapy and several debridement methods were performed before reconstruction. Two triangular double-transposition fasciocutaneous flap techniques as Z-plasty under local anesthesia was performed for all of the patients.
The flaps survived completely without any tissue loss. There were no major postoperative complications. One patient had recurrent infection after the flap procedure and was treated with antibiotic therapy. At 6 months of follow-up, all of the patients were able to return to normal activities of daily living with a high patient satisfaction rate.
Local sternal wound reconstruction is an effective, rapid, and simple with Z-plasty associated with low recurrence risk. We believe that Z-plasty can be used for recurrent local sternal wound infections as an alternative treatment option for selected patients without mechanical dehiscence.
胸骨切开术后的胸骨伤口感染与高发病率、高死亡率及住院时间延长相关。一期缝合后胸骨伤口感染的复发率高于预期。本研究的目的是展示我们采用连续Z成形术治疗复发性胸骨伤口感染的结果。
2015年3月至2017年3月期间，共有9例因胸骨切开术伴或不伴骨髓炎而出现复发性胸骨伤口感染的患者被转诊至我们的诊所。所有患者此前均因胸骨感染接受过一次或多次外科手术。在重建前进行了负压伤口治疗及多种清创方法。所有患者均在局部麻醉下采用两种三角形双转移筋膜皮瓣技术即Z成形术。
皮瓣完全存活，无任何组织丢失。无重大术后并发症。1例患者在皮瓣手术后出现复发性感染，接受了抗生素治疗。随访6个月时，所有患者均能恢复正常日常生活活动，患者满意度高。
局部胸骨伤口重建采用Z成形术有效、快速且简单，复发风险低。我们认为Z成形术可用于复发性局部胸骨伤口感染，作为无机械性裂开选中患者的一种替代治疗选择。
