Watanabe Hidetaka, Uemura Tetsuji, Yanai Tetsu, Kurokawa Masato, Harada Yoshimi, Ishihara Yasuhiro, Chuman Takahiro, Kawano Hiroshige
Department of Plastic and Reconstructive Surgery, Saga University School of Medicine, Saga, Japan.
Department of Plastic and Reconstructive Surgery, Kumamoto Red Cross Hospital, Kumamoto, Japan.
Plast Reconstr Surg Glob Open. 2020 Apr 30;8(4):e2776. doi: 10.1097/GOX.0000000000002776. eCollection 2020 Apr.
The frequency of sternomyelitis after cardiovascular surgery has been reported to be 0.4% -5%.
The treatment method used for 47 patients (29 male and 18 female) who developed sternomyelitis after sternotomy with tissue defects in the chest was examined retrospectively.
Of the original conditions, the most frequent was coronary artery disease undergoing bypass grafting (22 cases, 46.8%), followed by acute aortic dissection (10 cases, 21.3%). The number of times debridement was performed was: once, 35 cases; twice, 11 cases; 7 times, 1 case; and unknown, 2 cases. The most frequent time of occurrence of sternomyelitis was within 2 weeks after surgery (12 patients, 25.5%). A residual internal thoracic artery remained on both sides in 28 cases (59.6%), and only on the right side in 17 cases (36.2%); there was no remaining one in 2 cases (4.2%). The reconstruction method was a pectoralis major musculocutaneous flap in 31 cases (66.0%), internal mammary artery perforator flap in 7 cases (14.9%), rectus abdominis musculocutaneous flap in 4 cases (8.5%), omentum transplant in 3 cases (6.4%), superior epigastric artery perforator flap in 2 cases (4.3%), external abdominal oblique muscle flap in 1 case (2.1%), and latissimus dorsi musculocutaneous flap in 1 case (2.1%). The internal mammary artery perforator flap and the superior epigastric artery perforator flap have been effective treatment.
In 47 patients, our method of treatment for tissue defects of the chest wall after sternal osteomyelitis was examined, and an algorithm using less invasive management was proposed.
据报道，心血管手术后胸骨骨髓炎的发生率为0.4% - 5%。
回顾性研究47例（男性29例，女性18例）胸骨切开术后出现胸骨骨髓炎且伴有胸部组织缺损患者的治疗方法。
在原有疾病中，最常见的是接受冠状动脉搭桥术的冠心病（22例，46.8%），其次是急性主动脉夹层（10例，21.3%）。清创次数为：1次，35例；2次，11例；7次，1例；不详，2例。胸骨骨髓炎最常发生在术后2周内（12例，25.5%）。双侧保留胸廓内动脉的有28例（59.6%），仅右侧保留的有17例（36.2%）；2例（4.2%）无保留。重建方法为胸大肌肌皮瓣31例（66.0%）、胸廓内动脉穿支皮瓣7例（14.9%）、腹直肌肌皮瓣4例（8.5%）、大网膜移植3例（6.4%）、腹壁上动脉穿支皮瓣2例（4.3%）、腹外斜肌瓣1例（2.1%）、背阔肌肌皮瓣1例（2.1%）。胸廓内动脉穿支皮瓣和腹壁上动脉穿支皮瓣治疗效果良好。
对47例患者胸骨骨髓炎后胸壁组织缺损的治疗方法进行了研究，并提出了一种采用微创管理的治疗方案。
