Telfer J R, Chapple D C, Powell B W
Department of Plastic and Reconstructive Surgery, St George's Hospital, London, UK.
Br J Plast Surg. 1996 Jan;49(1):67-9. doi: 10.1016/s0007-1226(96)90190-3.
Dehiscence of a median sternotomy wound is a fortunately rare but potentially lethal complication of cardiac surgery. If conservative management, including irrigation and secondary closure, fails then osteomyelitis with or without necrosis of the sternum, costochondritis and anterior mediastinitis may result. In the face of such sequelae, radical debidement of the sternum and flap coverage is required. A variety of flaps may be used to cover the defect following debridement of the sternum, in particular pectoralis major or rectus abdominis muscle flaps and the omentum. We report the case of a 65-year-old man, who required an omental flap for sternal dehiscence after coronary artery bypass grafting and who subsequently presented with a metastatic colonic adenocarcinoma within the flap.
正中胸骨切开伤口裂开是心脏手术中一种虽幸运但罕见却可能致命的并发症。若保守治疗（包括冲洗和二期缝合）失败，可能会导致胸骨骨髓炎伴或不伴胸骨坏死、肋软骨炎及前纵隔炎。面对此类后遗症，需要对胸骨进行彻底清创并采用皮瓣覆盖。胸骨清创后可使用多种皮瓣来覆盖缺损，尤其是胸大肌或腹直肌肌皮瓣以及大网膜。我们报告一例65岁男性病例，该患者在冠状动脉搭桥术后因胸骨裂开需要使用大网膜皮瓣，随后在皮瓣内出现了转移性结肠腺癌。
