Hu Qiuming, Wu Kaisheng, Chen Zhang, Goia Adnan Abibe, Maloney Connor J, Maloney James D, Zhang Haibo
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Northeast Ohio Medical University, Rootstown, OH, USA.
J Thorac Dis. 2024 Nov 30;16(11):7807-7818. doi: 10.21037/jtd-24-1490. Epub 2024 Nov 29.
Deep sternal wound infection (DSWI) is a life-threatening postoperative complication of cardiac surgery. Currently, there are many therapies used to treat patients with DSWI. However, none of these therapies have been shown to be the optimal choice for patients with DSWI. Additionally, these methods may require additional facilities which limit their widespread use. Therefore, we aimed to investigate the effectiveness, safety, and risk factors related to the prognosis of DSWI patients treated with pectoralis major flap transposition (PMFT), a more concise method.
A retrospective, systemic analysis was conducted of DSWI patients at the Beijing Anzhen Hospital from January 2010 until December 2020. All the patients were diagnosed with DSWI according to the relevant guidelines, and treated with PMFT. The patients were divided into the following two groups based on their prognosis after treatment with PMFT: (I) the wound healing (WH) group; and (II) the delayed wound healing or death (DWHD) group. All the participants were followed up for 1 year.
In total, 9.7% (76/785) of the DSWI patients experienced DWHD in the present study. The all-cause mortality rate was 3.7% (29/785). While 90.3% (709/785) of the patients achieved WH after undergoing PMFT. The multivariate logistic regression model indicated that patients with diabetes mellitus, obesity, a history of smoking, abnormal liver function, anemia, chronic infection, immune disease, hypothermia, a longer gap time, and patients requiring extracorporeal membrane oxygenation (ECMO) assistance, salvage surgery, and secondary cardiac surgery were more likely to experience DWDH.
This study showed PMFT was a safe and effective method for treating DSWI after cardiac surgery. Patients with risk factors, such as those mentioned above, require more attention. Prospective studies should be conducted to explore the relationships among the novel risk factors and DSWI.
深部胸骨伤口感染（DSWI）是心脏手术危及生命的术后并发症。目前，有多种治疗方法用于治疗DSWI患者。然而，这些治疗方法均未被证明是DSWI患者的最佳选择。此外，这些方法可能需要额外的设备，这限制了它们的广泛应用。因此，我们旨在研究采用胸大肌肌瓣转移术（PMFT）治疗DSWI患者的有效性、安全性及与预后相关的危险因素，这是一种更简便的方法。
对2010年1月至2020年12月在北京安贞医院的DSWI患者进行回顾性、系统性分析。所有患者均根据相关指南诊断为DSWI，并接受PMFT治疗。根据PMFT治疗后的预后将患者分为以下两组：（I）伤口愈合（WH）组；（II）伤口延迟愈合或死亡（DWHD）组。所有参与者均随访1年。
在本研究中，共有9.7%（76/785）的DSWI患者出现DWHD。全因死亡率为3.7%（29/785）。而90.3%（709/785）的患者在接受PMFT后实现了伤口愈合。多因素logistic回归模型表明，患有糖尿病、肥胖、吸烟史、肝功能异常、贫血、慢性感染、免疫疾病、体温过低、间隔时间较长的患者，以及需要体外膜肺氧合（ECMO）辅助、挽救性手术和二次心脏手术的患者更有可能出现DWDH。
本研究表明PMFT是治疗心脏手术后DSWI的一种安全有效的方法。具有上述危险因素的患者需要更多关注。应进行前瞻性研究以探索新的危险因素与DSWI之间的关系。
