Ali Barkat, Shetty Anil, Borah Gregory, Demas Christopher, Schwartz Jess D
Department of Surgery, Division of Plastic and Reconstructive Surgery, University of New Mexico, Albuquerque, NM.
Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of New Mexico, Albuquerque, NM.
J Surg Case Rep. 2020 Apr 29;2020(4):rjaa035. doi: 10.1093/jscr/rjaa035. eCollection 2020 Apr.
Primary infection of the sternomanubrial joint (SMJ) is extremely rare. We present four consecutive cases who were all treated with SMJ resection (partial sternectomy), bilateral partial 2nd rib resection and immediate placement of temporary wound vacuum therapy followed by pectoralis major muscle flap closure. Average patient age was 35.5 years with male predominance (75%). All patients had intravenous drug use as underlying risk factor along with concomitant viral infections Hep C (75%) and HIV (25%). MSSA was identified in resection cultures in 75% of the patients. Delayed bilateral PMFC was achieved in all patients (average post-resection day 5). Response to treatment was excellent with no recurrent infections, no complications and zero 30-day mortalities. Our experience represents the largest reported case series in adults and would suggest that aggressive surgical resection followed by PMFC would appear to be the preferred treatment for all patients with SMJ infection.
胸锁关节（SMJ）的原发性感染极为罕见。我们报告了连续4例患者，均接受了胸锁关节切除术（部分胸骨切除术）、双侧第2肋部分切除术，并在术后立即进行伤口临时负压治疗，随后采用胸大肌肌瓣闭合伤口。患者平均年龄为35.5岁，以男性为主（占75%）。所有患者均有静脉吸毒这一潜在危险因素，同时伴有丙型肝炎病毒感染（占75%）和艾滋病病毒感染（占25%）。75%的患者在切除组织培养中检出耐甲氧西林金黄色葡萄球菌（MSSA）。所有患者均成功进行了延迟双侧胸大肌肌瓣闭合术（平均切除术后第5天）。治疗反应良好，无复发性感染、无并发症，30天死亡率为零。我们的经验是已报道的最大的成人病例系列，这表明积极的手术切除后行胸大肌肌瓣闭合术似乎是所有胸锁关节感染患者的首选治疗方法。
