Guedon C, Gandjbackch I, Piwnica A, Romano M, Andreassian B
Service de Chirurgie Cervico-maxillo-faciale, Hôpital Bichat-Claude Bernard, Paris.
Ann Chir Plast Esthet. 1994 Apr;39(2):191-7.
Infected median sternotomy often requires open wound management. A large thoracic defect usually results in subsequent exposure of heart, great vessels, aorto-coronary bypass grafting or vascular prosthesis. After thorough wound debridement, coverage with muscle transposition was carried out in a series of 167 cases observed over a period of 10 years. Transposition of both pectoralis major muscles on internal pedicles was performed in 75 cases. In 27 of these cases, internal mammary grafting did not preclude their use. Since 1986, intrathoracic transposition of the trapezius muscle has been our treatment of choice in 25 cases, most frequently combined with a double pectoralis major transposition. Rectus abdomini muscle flap was seldom used alone whereas latissimus dorsi was mainly used as a salvage flap. Muscle transposition provided effective heart and great vessel protection after acute hemorrhage in 18 cases. This series confirms that mortality and mean hospital stay have decreased dramatically since the routine use of muscle transposition.
感染性正中胸骨切开术通常需要开放伤口处理。巨大的胸部缺损通常会导致心脏、大血管、主动脉冠状动脉旁路移植术或血管假体随后暴露。在10年的时间里，对167例患者进行了观察，在彻底清创后，采用肌肉转位进行覆盖。75例患者采用带蒂胸大肌双转位。其中27例患者，胸廓内动脉移植并不妨碍其使用。自1986年以来，25例患者采用斜方肌胸内转位作为我们的首选治疗方法，最常与胸大肌双转位联合使用。腹直肌肌皮瓣很少单独使用，而背阔肌主要用作补救皮瓣。18例急性出血后，肌肉转位提供了有效的心脏和大血管保护。该系列证实，自常规使用肌肉转位以来，死亡率和平均住院时间显著降低。
