Scully H E, Leclerc Y, Martin R D, Tong C P, Goldman B S, Weisel R D, Mickleborough L L, Baird R J
J Thorac Cardiovasc Surg. 1985 Oct;90(4):523-31.
Between January of 1978 and December of 1983, 41 patients developed deep sternal infections with mediastinitis after cardiac operations. Between January of 1978 and December of 1981, 19 of these patients were treated with débridement, primary wound closure, and mediastinal antibiotic irrigation (Group I). Between January of 1982 and December of 1983, 22 patients were treated with débridement, open "clean" packing, and delayed wound closure by the technique of pectoral muscle flap mobilization, which preserves the thoracoacromial pedicles and the pectoral humeral attachments (Group II). The purpose of this study was to compare the results of the treatment of deep sternal infections after cardiac operations with these two techniques. The perioperative hemodynamic, operation, functional, and pathological profiles of both groups of patients were the same. The cosmetic and functional results were the same in both groups as were shoulder girdle and torso mobility. We conclude that either technique is equally effective in the management of patients in whom the serious complication of deep sternal infection with mediastinitis develops after cardiac operation, and we now recommend débridement and pectoral muscle flap closure in one stage.
1978年1月至1983年12月期间，41例患者在心脏手术后发生了伴有纵隔炎的深部胸骨感染。1978年1月至1981年12月期间，其中19例患者接受了清创、一期伤口缝合和纵隔抗生素冲洗治疗（第一组）。1982年1月至1983年12月期间，22例患者接受了清创、开放“清洁”填塞，并采用保留胸肩峰血管蒂和胸大肌肱骨附着点的胸大肌瓣转移技术延迟伤口缝合（第二组）。本研究的目的是比较采用这两种技术治疗心脏手术后深部胸骨感染的结果。两组患者的围手术期血流动力学、手术、功能和病理情况相同。两组患者的美容和功能结果相同，肩带和躯干活动度也相同。我们得出结论，在心脏手术后发生伴有纵隔炎的深部胸骨感染这一严重并发症的患者管理中，这两种技术同样有效，我们现在推荐一期清创和胸大肌瓣缝合。
