即刻与延迟胸骨重建术的分析：胸大肌推进瓣与翻转肌瓣的比较。

Analysis of Immediate versus Delayed Sternal Reconstruction with Pectoralis Major Advancement Versus Turnover Muscle Flaps.

机构信息

Division of Plastic Surgery, Montefiore Medical Center, Bronx, New York, United States.

出版信息

J Reconstr Microsurg. 2019 Oct;35(8):602-608. doi: 10.1055/s-0039-1688760. Epub 2019 May 10.

DOI:10.1055/s-0039-1688760

PMID:31075802

Abstract

BACKGROUND

The pectoralis major muscle flap is a versatile reconstructive option for deep sternal wound infections (DSWI). The timing and surgical technique of bilateral pectoralis major muscle advancement flaps versus unilateral pectoralis major muscle turnover and unilateral pectoralis major muscle advancement flap on patient outcomes remain to be elucidated. The purpose of this investigation was to compare timing, immediate versus delayed reconstruction, and the surgical technique in patients with deep sternal wounds infections on patient outcomes.

METHODS

A retrospective review of patients who underwent sternal reconstruction with pectoralis major muscle was conducted. Patients diagnosed with DSWI after undergoing cardiac surgery were included for analysis. Patients were divided by flap timing and flap type for analyses. Bivariate tests were performed to compare patient clinical characteristics. Outcomes of interest were rates of postoperative complications, same admission mortality, reoperation, readmission, operating room time, and length of stay.

RESULTS

A total of 88 patients were included for analyses ( = 57 bilateral advancement, = 31 unilateral advancement with unilateral turnover; = 62 immediate, and = 26 delayed). Baseline characteristics did not differ between groups of flap type or timing. When postoperative complication rates were compared, the rate of tissue necrosis was significantly greater in patients with unilateral advancement with unilateral turnover flaps ( = 6 [19.4%]) compared with bilateral advancement flaps ( = 2 [3.5%]; = 0.021). Mortality during admission did not differ with respect to flap type but differed significantly with respect to flap timing (immediate = 7 [11.3%], delayed = 9 [34.6%]; = 0.015). Length of stay differed significantly by both type and timing (type: bilateral advancement = 26.9 ± 22.6 days, unilateral turnover = 38.0 ± 26.7 days, = 0.042; timing: immediate = 26.8 ± 22.1 days, delayed = 40.2 ± 27.8, = 0.019).

CONCLUSION

Patients who underwent pectoralis major muscle advancement flaps had lower incidence of tissue necrosis. Furthermore, the timing of immediate sternal reconstruction was associated with a decreased hospital length of stay.

摘要

背景

胸大肌肌皮瓣是治疗深部胸骨伤口感染（DSWI）的一种多用途重建选择。双侧胸大肌推进皮瓣与单侧胸大肌翻转和单侧胸大肌推进皮瓣在患者结局方面的时机和手术技术仍有待阐明。本研究的目的是比较深部胸骨伤口感染患者的手术时机、即刻与延迟重建以及手术技术对患者结局的影响。

方法

对接受胸大肌肌皮瓣胸骨重建的患者进行回顾性研究。纳入因心脏手术后诊断为 DSWI 的患者进行分析。根据皮瓣时机和皮瓣类型对患者进行分组分析。采用双变量检验比较患者的临床特征。感兴趣的结局指标包括术后并发症发生率、同一入院死亡率、再次手术、再次入院、手术室时间和住院时间。

结果

共纳入 88 例患者进行分析（57 例双侧推进，31 例单侧推进伴单侧翻转；62 例即刻，26 例延迟）。皮瓣类型和时机两组患者的基线特征无差异。当比较术后并发症发生率时，单侧推进伴单侧翻转皮瓣组的组织坏死发生率明显高于双侧推进皮瓣组（6 [19.4%] vs. 2 [3.5%]；=0.021）。入院期间死亡率与皮瓣类型无关，但与皮瓣时机显著相关（即刻=7 [11.3%]，延迟=9 [34.6%]；=0.015）。住院时间与皮瓣类型和时机均有显著差异（类型：双侧推进=26.9±22.6 天，单侧翻转=38.0±26.7 天，=0.042；时机：即刻=26.8±22.1 天，延迟=40.2±27.8 天，=0.019）。