Chiang Sarah N, Chi David, Yesantharao Pooja S, Ha Austin Y, Vuong Linh, Sachar Ryan J, Arhewoh Reme, Parikh Rajiv P, Masood Muhammad F, Fox Ida K
Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University Medical Center, St Louis, Missouri.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, California.
Ann Thorac Surg Short Rep. 2022 Oct 22;1(1):199-202. doi: 10.1016/j.atssr.2022.09.014. eCollection 2023 Mar.
Sternal wound complications after median sternotomy increase morbidity and mortality, and plastic and reconstructive surgery is often consulted to provide closure with flap reconstruction. In this study, we investigated how the timing of plastic surgery involvement may influence outcomes in this setting.
We performed a retrospective review of patients with sternal wound complications cared for at our institution during a 10-year period. Patients were stratified into quartiles based on time from detected complication to plastic surgery consultation. Primary outcome variables included morbidity (postoperative complications and reoperation) and all-cause mortality at 1 year. Univariable followed by multivariable logistic regression was performed to characterize risk factors for these adverse outcomes.
A total of 188 patients composed the study population. The time to plastic surgery consultation quartiles were as follows: immediate, 0 to 1 days (n = 46); early, 2 to 5 days (n = 50); delayed, 6 to 14 days (n = 42); and late, >14 days (n = 50). Patient demographics, comorbidities, and reconstructive characteristics did not differ across groups. Increased time to plastic surgery consultation was associated with sternal wound reoperations ( = .026), 1-year mortality ( = .008), hematoma ( = .044), and sternal dehiscence recurrence ( = .019). Multivariable regression demonstrated that increased time to plastic surgery consultation was associated with increased sternal wound reoperations (odds ratio [OR], 1.1; = .041), sternal wound recurrence (OR, 1.5; = .018), and mortality (OR, 1.3; = .037).
Early involvement of plastic surgery in treating sternal wounds is significantly associated with a reduction in mortality, recurrence of sternal dehiscence, and reoperation. Successful treatment of these challenging complications requires multidisciplinary collaboration, and prompt plastic surgery consultation is recommended.
正中开胸术后胸骨伤口并发症会增加发病率和死亡率，通常会咨询整形和重建外科以采用皮瓣重建进行闭合。在本研究中，我们调查了整形手术介入的时机如何影响这种情况下的结局。
我们对在10年期间在我们机构接受治疗的胸骨伤口并发症患者进行了回顾性研究。根据从检测到并发症到咨询整形手术的时间，将患者分为四分位数。主要结局变量包括发病率（术后并发症和再次手术）和1年时的全因死亡率。进行单变量随后多变量逻辑回归以确定这些不良结局的危险因素。
共有188名患者组成研究人群。整形手术咨询的四分位数时间如下：即时，0至1天（n = 46）；早期，2至5天（n = 50）；延迟，6至14天（n = 42）；晚期，>14天（n = 50）。各组患者的人口统计学、合并症和重建特征无差异。整形手术咨询时间延长与胸骨伤口再次手术（P = .026）、1年死亡率（P = .008）、血肿（P = .044）和胸骨裂开复发（P = .019）相关。多变量回归表明，整形手术咨询时间延长与胸骨伤口再次手术增加（比值比[OR]，1.1；P = .041）、胸骨伤口复发（OR，1.5；P = .018）和死亡率（OR，1.3；P = .037）相关。
整形手术早期介入治疗胸骨伤口与死亡率降低、胸骨裂开复发和再次手术显著相关。成功治疗这些具有挑战性的并发症需要多学科协作，建议及时咨询整形手术。
