Horriat Narges L, McCandless Martin G, Humphries Laura S, Ghanamah Mohammed, Kogon Brian E, Hoppe Ian C
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Division of Cardiothoracic Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA.
J Card Surg. 2022 Nov;37(11):3695-3702. doi: 10.1111/jocs.16841. Epub 2022 Aug 18.
Management of sternal wound infections (SWIs) in pediatric patients following congenital heart surgery can be extremely difficult. Patients with congenital cardiac conditions are at risk for complications such as sternal dehiscence, infection, and cardiopulmonary compromise. In this study, we report a single-institution experience with pediatric SWIs.
Fourteen pediatric patients requiring plastic surgery consultation for complex sternal wound closure were included. A retrospective chart review was performed with the following variables of interest: demographic data, congenital cardiac condition, respective surgical palliations, development of mediastinitis, causative organism, number of debridements, presence of sternal wires, and choice of flap coverage. Primary endpoints included achieved chest wall closure and overall survival.
Of the 14 patients, 8 (57%) were diagnosed with culture-positive mediastinitis. The sternum remained wired at the time of final flap closure in eight (57%) patients. All patients were reconstructed with pectoralis major flaps, except one (7%) who also received an omental flap and two (14%) who received superior rectus abdominis flaps. One patient (7%) was treated definitively with negative pressure wound therapy, and one (7%) was too unstable for closure. Six patients developed complications, including one (7%) with persistent mediastinitis, two (14%) with hematoma formation, one (7%) with abscess, and one (7%) with skin necrosis requiring subsequent surgical debridement. There were three (21%) mortalities.
The management of SWI in congenital cardiac patients is challenging. The standard tenets for management of SWI in adults are loosely applicable, but additional considerations must be addressed in this unique subset population.
先天性心脏病手术后小儿患者胸骨伤口感染（SWIs）的管理可能极其困难。患有先天性心脏病的患者有发生诸如胸骨裂开、感染和心肺功能不全等并发症的风险。在本研究中，我们报告了一家机构处理小儿SWIs的经验。
纳入14例因复杂胸骨伤口闭合需要整形外科会诊的小儿患者。对以下感兴趣的变量进行回顾性病历审查：人口统计学数据、先天性心脏病状况、各自的手术姑息治疗、纵隔炎的发生、病原体、清创次数、胸骨钢丝的存在情况以及皮瓣覆盖的选择。主要终点包括实现胸壁闭合和总体生存率。
14例患者中，8例（57%）被诊断为培养阳性纵隔炎。8例（57%）患者在最终皮瓣闭合时胸骨仍有钢丝固定。除1例（7%）还接受了网膜瓣和2例（14%）接受了腹直肌上瓣外，所有患者均采用胸大肌瓣重建。1例患者（7%）接受了负压伤口治疗，1例（7%）因病情过于不稳定无法闭合。6例患者出现并发症，包括1例（7%）持续性纵隔炎、2例（14%）血肿形成、1例（7%）脓肿和1例（7%）皮肤坏死需要后续手术清创。有3例（21%）死亡。
先天性心脏病患者SWI的管理具有挑战性。成人SWI管理的标准原则大致适用，但在这一独特的亚组人群中必须考虑其他因素。
