Pairolero P C, Arnold P G
J Thorac Cardiovasc Surg. 1984 Sep;88(3):357-64.
During a 7 year period, 38 consecutive patients (31 male and seven female) had repair of an infected sternotomy wound. Their mean age was 56 years (range 13 to 78 years). Sternotomy was performed for cardiac disease in 34 patients. Staphylococcus aureus was the most commonly cultured organism. All patients required sternal debridement, and 17 had resection. Reconstruction was with muscle flaps in 37 patients, omental transposition in one, and both in four. Sixty-seven muscle transpositions were performed (63 pectoralis major, three rectus abdominis, and one latissimus dorsi). The mean number of operations was three (range one to seven). No deaths occurred within 30 days postoperatively. Significant early complications occurred in nine patients. The mean duration of hospitalization was 24.9 days (range 8 to 67 days). All patients were dismissed with a healed sternum. The mean length of follow-up was 24.8 months (range 1 to 81 months). None of the five late deaths were related to sepsis or to wound reconstruction. Recurrent sternal infection occurred in five patients (13.2%). Four of the five patients responded to additional debridement and muscle transposition, and the fifth patient refused further treatment. Of the 38 patients, 33 were alive at the time of this report, 32 with excellent results. We conclude that muscle transposition is an excellent method of management for recalcitrant median sternotomy wounds.
在7年期间，38例连续患者（31例男性和7例女性）接受了感染性胸骨切开伤口的修复。他们的平均年龄为56岁（范围13至78岁）。34例患者因心脏疾病行胸骨切开术。金黄色葡萄球菌是最常培养出的微生物。所有患者均需进行胸骨清创，17例进行了切除。37例患者采用肌瓣重建，1例采用网膜移位，4例两者联合应用。共进行了67次肌移位（63次胸大肌、3次腹直肌和1次背阔肌）。平均手术次数为3次（范围1至7次）。术后30天内无死亡病例。9例患者出现显著的早期并发症。平均住院时间为24.9天（范围8至67天）。所有患者出院时胸骨均已愈合。平均随访时间为24.8个月（范围1至81个月）。5例晚期死亡均与脓毒症或伤口重建无关。5例患者（13.2%）发生复发性胸骨感染。5例患者中有4例经再次清创和肌移位后好转，第5例患者拒绝进一步治疗。在本报告发布时，38例患者中有33例存活，32例效果良好。我们得出结论，肌移位是治疗顽固性正中胸骨切开伤口的一种极好方法。
