Josa M, Khuri S F, Braunwald N S, VanCisin M F, Spencer M P, Evans D A, Barsamian E M
J Thorac Cardiovasc Surg. 1986 Apr;91(4):598-603.
Intraoperative closure of the median sternotomy after cardiac operations in patients with complications, including severe postoperative bleeding, impaired cardiac function caused by myocardial edema, and cardiac dilatation, may lead to a critical and possibly fatal deterioration of hemodynamic function. In an effort to prevent this complication, we delayed mediastinal closure in 15 patients, covering the wound temporarily with a sheet of rubber latex (Esmarch bandage). An oval patch of this material was sized and sutured to the skin edges with a continuous suture. This technique provided easy and fast access to the mediastinal structures in four of the 15 patients who required multiple surgical interventions in the early postoperative period. Delayed closure was indicated for severe bleeding in 10 patients, heart compression in four patients, and severe postbypass arrhythmias in one patient. Definitive closure of the chest was delayed until satisfactory hemostasis was achieved or the heart size returned to normal. Thirteen of the 15 patients were long-term survivors, none of them had wound infections, and their wounds healed well. Delayed closure of the median sternotomy was an effective and safe approach in these groups of critically ill patients.
在心脏手术后出现并发症（包括严重术后出血、心肌水肿导致的心功能受损以及心脏扩张）的患者中，术中关闭正中胸骨切开术可能会导致血流动力学功能严重且可能致命的恶化。为了预防这种并发症，我们对15例患者延迟了纵隔关闭，用一块橡胶乳胶片（埃斯马赫绷带）暂时覆盖伤口。将这种材料剪成椭圆形，用连续缝线缝合到皮肤边缘。在术后早期需要多次手术干预的15例患者中，有4例通过这种技术能够轻松、快速地进入纵隔结构。延迟关闭适用于10例严重出血患者、4例心脏受压患者和1例严重体外循环后心律失常患者。胸部的最终关闭延迟到实现满意的止血或心脏大小恢复正常。15例患者中有13例是长期存活者，他们均无伤口感染，伤口愈合良好。对于这些危重症患者群体，延迟关闭正中胸骨切开术是一种有效且安全的方法。
