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心外科胸骨切开术后纵隔炎的治疗及胸部重建：来自圣保罗大学医学院附属医院心脏研究所的报告

Treatment and Chest Reconstruction for Mediastinitis Following Sternotomy for Cardiac Surgery at the Heart Institute of the University of São Paulo Medical School.

机构信息

Plastic Surgery Division, Universidade de São Paulo, São Paulo, São Paulo, Brazil.

Cardiothoracic Surgery Department, Universidade de São Paulo, São Paulo, São Paulo, Brazil.

出版信息

Braz J Cardiovasc Surg. 2021 Aug 6;36(4):565-570. doi: 10.21470/1678-9741-2020-0117.

DOI:10.21470/1678-9741-2020-0117
PMID:33577255
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8522307/
Abstract

This study presents the method used for chest reconstruction and treatment of mediastinitis following cardiac surgery at the Heart Institute of the University of São Paulo Medical School. After infection control with antibiotic therapy associated with aggressive surgical debridement and negative pressure wound therapy, chest reconstruction is performed using flaps. The advantages and disadvantages of negative pressure wound therapy are discussed, as well as options for flap-based chest reconstruction according to the characteristics of the patient and sternum. Further studies are needed to provide evidence to support the decisions when facing this great challenge.

摘要

本研究介绍了圣保罗大学医学院心脏病研究所心脏手术后胸部重建和治疗纵隔炎的方法。在使用抗生素治疗控制感染并进行积极的清创和负压伤口治疗后，使用皮瓣进行胸部重建。讨论了负压伤口治疗的优缺点，以及根据患者和胸骨的特点选择基于皮瓣的胸部重建的方案。需要进一步的研究提供证据，以支持在面临这一巨大挑战时的决策。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9889/8522307/7c125668e1eb/rbccv-36-04-0565-g05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9889/8522307/386e5c845410/rbccv-36-04-0565-g01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9889/8522307/e42fd3d6af62/rbccv-36-04-0565-g02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9889/8522307/a809f61eccba/rbccv-36-04-0565-g03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9889/8522307/f2e7ce2f45ed/rbccv-36-04-0565-g04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9889/8522307/7c125668e1eb/rbccv-36-04-0565-g05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9889/8522307/386e5c845410/rbccv-36-04-0565-g01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9889/8522307/e42fd3d6af62/rbccv-36-04-0565-g02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9889/8522307/a809f61eccba/rbccv-36-04-0565-g03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9889/8522307/f2e7ce2f45ed/rbccv-36-04-0565-g04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9889/8522307/7c125668e1eb/rbccv-36-04-0565-g05.jpg

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引用本文的文献

1
Successful pedicled vertical rectus abdominis myocutaneous flap reconstruction with negative-pressure wound therapy for deep sternal wound infection: a case report and comprehensive review.采用负压伤口治疗成功进行带蒂腹直肌肌皮瓣重建治疗深部胸骨伤口感染：一例报告及综合综述
Front Surg. 2023 Nov 6;10:1268555. doi: 10.3389/fsurg.2023.1268555. eCollection 2023.

本文引用的文献

1
Negative pressure wound therapy with instillation: International consensus guidelines update.负压伤口治疗联合灌洗：国际共识指南更新。
Int Wound J. 2020 Feb;17(1):174-186. doi: 10.1111/iwj.13254. Epub 2019 Oct 30.
2
Sternal reconstruction after post-sternotomy mediastinitis.胸骨切开术后纵隔炎后的胸骨重建。
J Cardiothorac Surg. 2017 Nov 2;12(1):94. doi: 10.1186/s13019-017-0656-7.
3
Post-sternotomy mediastinitis in the modern era.现代胸骨切开术后纵隔炎
J Card Surg. 2017 Sep;32(9):556-566. doi: 10.1111/jocs.13189. Epub 2017 Aug 22.
4
Prevention and management of sternal wound infections.胸骨伤口感染的预防与管理
J Thorac Cardiovasc Surg. 2016 Oct;152(4):962-72. doi: 10.1016/j.jtcvs.2016.01.060. Epub 2016 Aug 8.
5
Preoperative risk factors for mediastinitis after cardiac surgery: analysis of 2768 patients.
Rev Bras Cir Cardiovasc. 2012 Apr-Jun;27(2):203-10. doi: 10.5935/1678-9741.20120035.
6
Chest wall reconstruction of severe mediastinitis with intercostal artery-based pedicled vertical rectus abdominis muscle flap with oblique-designed skin pedicle.
Ann Plast Surg. 2011 Sep;67(3):269-71. doi: 10.1097/SAP.0b013e3181f77b8c.
7
In search of a standardized treatment for poststernotomy mediastinitis.寻找胸骨切开术后纵隔炎的标准化治疗方法。
Thorac Cardiovasc Surg. 2011 Feb;59(1):15-20. doi: 10.1055/s-0030-1250335. Epub 2011 Jan 17.
8
Management of sternal wounds with bilateral pectoralis major myocutaneous advancement flaps in 114 consecutively treated patients: refinements in technique and outcomes analysis.114例连续接受双侧胸大肌肌皮推进皮瓣治疗的胸骨伤口处理：技术改进与结果分析
Plast Reconstr Surg. 2004 Sep 1;114(3):676-83. doi: 10.1097/01.prs.0000130939.32238.3b.
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Reconstruction of the median sternotomy wound dehiscence using the latissimus dorsi myocutaneous flap.采用背阔肌肌皮瓣修复正中胸骨切开术后伤口裂开。
J Cardiovasc Surg (Torino). 2001 Jun;42(3):359-64.