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胸骨切开术后伤口愈合并发症——病因、预防及治疗——对一个老问题的新审视

Wound Healing Complications After Sternotomy-Causes, Prevention, and Treatment-A New Look at an Old Problem.

作者信息

Jęczmyk Agata, Krych Sebastian, Jekiełek Małgorzata, Jurkiewicz Michał, Kowalczyk Paweł, Kramkowski Karol, Hrapkowicz Tomasz

机构信息

Students' Scientific Association, III Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland.

Student's Scientific Association, Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland.

出版信息

J Clin Med. 2024 Dec 6;13(23):7431. doi: 10.3390/jcm13237431.

Abstract

Median sternotomy is one of the most common procedures in cardiac surgery. This corresponds to the relatively high frequency of infections where surgical incisions are performed. In the prevention of healing disorders, the medical staff intervention is important, as is the patient. The management of wound infection after sternotomy requires a holistic approach. It requires the implementation of adequate antibiotic therapy, surgical treatment of the wound, and, if necessary, reconstruction of tissue defects using skin, muscle, and skin-muscle grafts or greater omentum. The prevention of surgical site infection should be based on asepsis and antisepsis at every stage of surgical treatment; the elimination of modifiable risk factors; and an appropriate, staged, and tension-free technique of chest closure. The described actions are aimed at avoiding the most serious complication associated with a high mortality rate in the form of mediastinitis. The therapeutic procedures are strictly dependent on the degree of tissue involvement and the presented clinical manifestation. During the preparation of this manuscript, scientific publications available on the Pubmed platform were analyzed. The scope of the search was limited to the years 2014-2024. The key words were "sternotomy wound infection". A total of 114 publications were analyzed, and 56 of them were included. A total of 23 papers were used to discuss the topic.

摘要

正中胸骨切开术是心脏外科最常见的手术之一。这与手术切口部位感染的相对高发生率相对应。在预防愈合障碍方面,医护人员的干预很重要,患者也是如此。胸骨切开术后伤口感染的管理需要采取整体方法。这需要实施适当的抗生素治疗、伤口的手术处理,必要时使用皮肤、肌肉、皮肤肌肉移植物或大网膜重建组织缺损。手术部位感染的预防应基于手术治疗各阶段的无菌和防腐措施;消除可改变的风险因素;以及采用适当、分阶段且无张力的胸部闭合技术。上述措施旨在避免以纵隔炎形式出现的、与高死亡率相关的最严重并发症。治疗程序严格取决于组织受累程度和所呈现的临床表现。在撰写本手稿期间,对Pubmed平台上的科学出版物进行了分析。搜索范围限于2014年至2024年。关键词为“胸骨切开术伤口感染”。共分析了114篇出版物,其中56篇被纳入。共使用23篇论文来讨论该主题。

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Post-sternotomy mediastinitis in the modern era.现代胸骨切开术后纵隔炎
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Sternal reconstruction after post-sternotomy mediastinitis.胸骨切开术后纵隔炎后的胸骨重建。
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本文引用的文献

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Deep Sternal Wound Infection: Diagnosis, Treatment and Prevention.胸骨深部伤口感染:诊断、治疗与预防。
J Cardiothorac Vasc Anesth. 2020 Jun;34(6):1602-1613. doi: 10.1053/j.jvca.2019.09.019. Epub 2019 Sep 18.
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Sternal reconstruction after post-sternotomy mediastinitis.胸骨切开术后纵隔炎后的胸骨重建。
J Cardiothorac Surg. 2017 Nov 2;12(1):94. doi: 10.1186/s13019-017-0656-7.

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