Elassal Ahmed Abdelrahman, Al-Ebrahim Khalid Ebrahim, Al-Radi Osman Osama, Jabbad Husain Hamza, Eldib Osama Saber
King Abdulaziz University Hospital, Cardiac Surgery Unit, Jeddah, Saudi Arabia.
Zagazig University Hospital, Cardiothoracic Surgery Department, Zagazig, Egypt.
Heart Surg Forum. 2020 Feb 27;23(1):E076-E080. doi: 10.1532/hsf.2649.
Sternal wound complications pose a tremendous challenge post-cardiac surgery. There’s no consensus or clear guidelines to deal with them. We propose that simple and more objective classification helps to organize the range of sternal wound complications and suggest a relevant treatment strategy.
One-hundred-sixteen cases of sternal wound complications retrospectively were reviewed out of 2,391 adult patients, who underwent full sternotomy during cardiac surgery from 2006 to 2018. Eighty-six cases conservatively were managed and the remaining 30 cases required surgical intervention. More objective classification was proposed and less invasive fasciocutaneous flap was considered for nearly all reconstructive procedures.
The incidence of sternal wound complications was 4.8%. Conservative management was adopted for 86 cases, mean duration was 11.19 ± 9.8 days. Surgical management was performed in 30 patients (25.86%); 28 (93.3%) of whom recovered with good outcomes with less invasive fasciocutaneous flap done for 13 cases. Two cases had recurrence; one conservatively was managed and other was reoperated and healed well. The most common organisms in recurrent infections were N. coagulase (29.8%), Klebsiella (12.5%), pseudomonas (10.5%), and MRSA (10.5%). We had 4 mortalities. None of the mortalities were related to sternal wound complications; one was related to the cardiac surgery.
Sternal wound complications are grave events. Objective classification and proper management selection will gain better outcomes.
胸骨伤口并发症是心脏手术后面临的巨大挑战。目前对于如何处理这些并发症尚无共识或明确的指南。我们提出，简单且更客观的分类有助于梳理胸骨伤口并发症的范围，并提出相关的治疗策略。
回顾性分析了2006年至2018年期间在心脏手术中接受全胸骨切开术的2391例成年患者中的116例胸骨伤口并发症病例。其中86例采用保守治疗，其余30例需要手术干预。提出了更客观的分类方法，并且几乎所有重建手术均考虑采用侵入性较小的筋膜皮瓣。
胸骨伤口并发症的发生率为4.8%。对86例采用保守治疗，平均持续时间为11.19±9.8天。30例患者（25.86%）接受了手术治疗；其中28例（93.3%）恢复良好，13例采用侵入性较小的筋膜皮瓣进行手术。2例复发；1例采用保守治疗，另1例再次手术并愈合良好。复发性感染中最常见的病原体是凝固酶阴性葡萄球菌（29.8%）、克雷伯菌（12.5%）、假单胞菌（10.5%）和耐甲氧西林金黄色葡萄球菌（10.5%）。我们有4例死亡病例。所有死亡病例均与胸骨伤口并发症无关；1例与心脏手术有关。
胸骨伤口并发症是严重事件。客观的分类和恰当的治疗选择将获得更好的结果。
