Sugiyama Kayo, Watanuki Hirotaka, Okada Masaho, Futamura Yasuhiro, Imazu Rintaro, Makino Satoshi, Matsuyama Katsuhiko
Department of Cardiac Surgery Aichi Medical University Hospital Nagakute Japan.
Clin Case Rep. 2020 Sep 28;8(12):3154-3157. doi: 10.1002/ccr3.3356. eCollection 2020 Dec.
Few studies have reported resternotomy after an omental flap procedure. We describe the case of a 78-year-old man who received resternotomy after omental flap procedure for deep sternal wound infection and successfully underwent coronary artery bypass grafting. Although preoperative computed tomography showed funnel chest and limited space between the sternum and omentum, resternotomy was performed safely using circular electric sternum saw under partial cardiopulmonary bypass. Because the omentum functioned as cushioning material between the sternum and mediastinal organs, no injuries of the mediastinal organs occurred. An ultrasonic scalpel effectively dissected between the omentum and mediastinal organs, especially above the ascending aorta. The targeted coronary arteries were easily detected. The patient experienced no major cardiac or infectious events for three months. An ultrasonic scalpel is recommended for dissecting between the omentum and mediastinal organs.
很少有研究报道过在网膜瓣手术后进行再次胸骨切开术。我们描述了一例78岁男性的病例，该患者因深部胸骨伤口感染在网膜瓣手术后接受了再次胸骨切开术，并成功进行了冠状动脉搭桥术。尽管术前计算机断层扫描显示有漏斗胸且胸骨与网膜之间的空间有限，但在部分体外循环下使用环形电动胸骨锯安全地进行了再次胸骨切开术。由于网膜起到了胸骨与纵隔器官之间的缓冲材料的作用，因此未发生纵隔器官损伤。超声刀有效地在网膜与纵隔器官之间进行了分离，尤其是在升主动脉上方。目标冠状动脉易于检测。患者在三个月内未发生重大心脏或感染事件。建议使用超声刀在网膜与纵隔器官之间进行分离。
