我们治疗前胸壁感染的经验（2015 - 2021年）

Our Experiences in the Treatment of Anterior Chest Wall Infections (2015 - 2021).

作者信息

Banjanovic Bedrudin, Haxibeqiri Karabic Ilirijana, Straus Slavenka, Granov Nermin, Kabil Edin, Jakirlic Malik, Pilav Ilijaz, Djedovic Muhamed

机构信息

Clinic for Cardiovascular Surgery, Clinical Center University of Sarajevo, Bosnia and Herzegovina.

Clinic for Plastic and Reconstructive Surgery, Clinical Center University of Sarajevo, Bosnia and Herzegovina.

出版信息

Mater Sociomed. 2022 Jun;34(2):142-148. doi: 10.5455/msm.2022.34.142-148.

DOI:10.5455/msm.2022.34.142-148

PMID:36199840

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9478535/

Abstract

BACKGROUND

Sternotomy is a classical surgical procedure for approaching the heart and mediastinum. Sternotomy wound infections can be superficial or deep.

OBJECTIVE

The aim of this study is to retrospectively evaluate the results of two treatments for deep sternal wound infection (DSWI), closed treatment (debridement, refixation and retrosternal irrigation) and open treatment (debridement, VAC therapy and then pectoral flap).

METHODS

Retrospective analysis of two methods of treatment of DSWI in the period of six years. The first group (G1): surgical debridement, sternum fixation with, if necessary, retrosternal irrigation. The second group (G2): surgical debridement, open sternum with VAC therapy and subsequent pectoral flap with sternum refixation if necessary. Sternotomy wound infection will be classified according to the depth of the affected areas and the time of infection. Risk factors, outcome, local findings, number of revisions, number of hospital treatment days, types of isolates, etiology of sternotomy, time from onset of sternal instability to first surgical treatment will be observed.

RESULTS

The number of patients with DSWI was 16, which represents 1% of all sternotomy in the observed period. Mortality in the DSWI group was 35%. Surgical myocardial revascularization was initially performed in 73% of patients with DSWI. Two risk factors for DSWI were in 32% of patients and 25% had diabetes mellitus. The average time for DSWI development in G1 was 10 days (min 0, max 30) and in G2 was 20 days (min 12, max 30). Number of revisions in G1 (min 1, max 2), G2 (min 1, max 3). Average number of hospital days were in G1 23.50 days (SD 13.15), and in G2 38.17 days (SD 28.65). The sternum was osteomyelitic and fragmented in 20% of patients. More than one revision occurred in 40% of patients. The main initial isolate was Enterococcus faecalis in 27% of all DSWI (dominantly in G1 2/3 of all).

CONCLUSION

We found that there is no statistically significant difference in observed treatments, and that each treatment has its own indications. We suggested that studies with a larger sample are needed for a definite opinion on this issue.

摘要

背景

胸骨切开术是一种用于接近心脏和纵隔的经典外科手术。胸骨切开术伤口感染可分为表浅感染或深部感染。

目的

本研究旨在回顾性评估两种治疗深部胸骨伤口感染（DSWI）的方法的效果，即闭合治疗（清创、重新固定和胸骨后冲洗）和开放治疗（清创、负压伤口治疗，然后行胸大肌皮瓣转移术）。

方法

对六年期间DSWI的两种治疗方法进行回顾性分析。第一组（G1）：手术清创，必要时进行胸骨固定及胸骨后冲洗。第二组（G2）：手术清创，开放胸骨并进行负压伤口治疗，必要时随后行胸大肌皮瓣转移术并重新固定胸骨。胸骨切开术伤口感染将根据受影响区域的深度和感染时间进行分类。观察危险因素、治疗结果、局部表现、翻修次数、住院治疗天数、分离菌株类型、胸骨切开术的病因、从胸骨不稳定开始到首次手术治疗的时间。

结果

DSWI患者有16例，占观察期内所有胸骨切开术患者的1%。DSWI组的死亡率为35%。73%的DSWI患者最初进行了外科心肌血运重建。32%的患者有两种DSWI危险因素，25%的患者患有糖尿病。G1组DSWI发生的平均时间为10天（最小值0，最大值30），G2组为20天（最小值12，最大值30）。G1组的翻修次数（最小值1，最大值2），G2组（最小值1，最大值3）。G1组的平均住院天数为23.50天（标准差13.15），G2组为38.17天（标准差28.65）。20%的患者胸骨发生骨髓炎且有骨折。40%的患者进行了不止一次翻修。在所有DSWI中，主要的初始分离菌株是粪肠球菌，占27%（在G1组中占所有的2/3）。