Şahin Mehmet Furkan, Yazıcıoğlu Alkın, Beyoğlu Muhammet Ali, Yekeler Erdal
Department of Thoracic Surgery and Lung Transplantation, Health Sciences University, Ankara City Hospital, Ankara, Turkey.
Turk Gogus Kalp Damar Cerrahisi Derg. 2022 Jan 28;30(1):57-65. doi: 10.5606/tgkdc.dergisi.2022.20958. eCollection 2022 Jan.
This study aims to evaluate the results of the method we used to treat sternal dehiscence and mediastinitis due to median sternotomy following open heart surgery.
Between July 2014 and March 2019, a total of 13 patients (8 males, 5 females; mean age: 60.3±2.9 years; range, 33 to 74 years) who underwent sternal reconstruction procedure and developed sternal dehiscence and mediastinitis after cardiac surgery were retrospectively analyzed. Data of the patients were retrieved from the hospital records.
Before the procedure, reconstruction was performed by using the Robiscek technique in three cases and a conventional rewiring technique was used in one case. Except for one case, all the other cases had sternal purulent discharge (n=12, 92%). Except for four cases, all cases had at least two fracture lines in the sternum (n=9, 69%). One to 10 sessions of (median=4) vacuum-assisted closure therapy were used in cases before the procedure. At least two bars were placed between the opposite ribs for sternal fixation. Except for three cases, all of the cases were placed transdiaphragmatic harvested omentum in the sternal cavity. Seroma and local infection recurrence occurred in two cases (n=2, 15.3%) and incisional hernia in one case (n=1, 7.6%). Thoracic stabilization was successfully achieved in all cases.
Thoracic stabilization can be successfully achieved in complicated sternal dehiscence cases with sternal reconstruction with STRATOS system supported by vacuum-assisted closure therapy, until the culture turns negative in the preoperative period and by the use of transdiaphragmatic omentum intraoperatively inside the sternal cavity.
本研究旨在评估我们用于治疗心脏直视手术后正中开胸所致胸骨裂开和纵隔炎的方法的效果。
回顾性分析2014年7月至2019年3月期间，共13例（8例男性，5例女性；平均年龄：60.3±2.9岁；范围33至74岁）接受胸骨重建手术且心脏手术后发生胸骨裂开和纵隔炎的患者。患者数据从医院记录中获取。
术前，3例采用Robiscek技术进行重建，1例采用传统重新布线技术。除1例患者外，其他所有患者均有胸骨脓性分泌物（n = 12，92%）。除4例患者外，所有患者胸骨至少有两条骨折线（n = 9，69%）。术前患者使用1至（中位数 = 4）10次负压封闭引流治疗。在相对的肋骨之间至少放置两根钢板进行胸骨固定。除3例患者外，所有患者均在胸骨腔内放置经膈获取的大网膜。2例患者（n = 2，15.3%）发生血清肿和局部感染复发，1例患者（n = 1，7.6%）发生切口疝。所有患者均成功实现胸廓稳定。
在复杂的胸骨裂开病例中，通过负压封闭引流治疗支持的STRATOS系统进行胸骨重建，直到术前培养结果转为阴性，并在术中在胸骨腔内使用经膈大网膜，可成功实现胸廓稳定。
