摘要
目的探讨胸大肌瓣翻转、伤口内无异物存留技术成形治疗胸骨切口深部感染的安全性与有效性。方法纳入我院2016年6~12月胸骨切口深部感染患者23例,男13例、女10例,年龄4~73(54.5±19.5)岁。8例合并糖尿病,1例合并慢性阻塞性肺疾病和脑梗塞。分型:Ⅱ型18例,Ⅲ型5例;5例纵隔残存脓腔。彻底清创伤口后,采用肌瓣成形新技术治疗胸骨切口感染:游离胸大肌将其外侧切断制备成肌瓣,向内翻转填充于胸骨缺损处,用减张缝合法将肌瓣填充并固定,切口全层缝合皮下皮肤。结果胸骨清创后胸骨缺损成形使用双侧胸大肌瓣17例、单侧6例,切口Ⅰ期愈合21例(91.3%),切口皮肤延迟愈合2例,均自行愈合。胸廓无反常呼吸22例,因合并症致多器官衰竭死亡1例。平均住院时间10.6 d。术后1个月胸部CT检查切口愈合良好。术后随访5.9(3~9)个月,患者未诉不适。结论胸大肌瓣翻转、伤口内无异物存留技术成形治疗胸骨切口深部感染技术独特,有Ⅰ期愈合率高、并发症少、住院时间短的优势。
Objective To study the effect of deep sternal wound infections （DSWIs） treated by the techniques of pectoral major muscular（PM） turnover and non-suture remain after the wound restitution. Method We retrospectively analyzed the clinical data of 23 patients with DSWIs in our hospital between June 2016 and December 2016. There were 13 males and 10 females at age of 4-73（54.5±19.5） years. There were 8 patients with concomitant diabetes mellitus and 1 patient with chronic obstructive pulmonary disease（COPD） and brain infarction. Eigteen patients were of type II, 5 patients of type III according to Pairolero＇ classification in the DSWIs. Five patients were with remaining abscess cavity in the mediastinum by thoracic compute tomography（CT）. Under general anesthesia the DSWIs debrided thoroughly. The PM elevated from the anterior pectoralis major fascia off subcutaneous tissue to lateral to anterior axillary line, the PM catted off, then made to the muscle flap, turnover PM flap filled and fixed to sternal wound by lighten tensile suture, the subcutaneous tissue and skin sutured by cutting full-thickness. Results The sternal reconstruction after debridement of the sternal wound was used by bilateral PM flap in the 17 patients, unilateral PM in 6 patients. There were 21（91.3%） patients in stage I healing, 2 patients deferment healing of local cut skin without reoperation. There were 22 patients with non-paradoxical breathing during the postoperation. One death resulted from multiple-organ failure of the concomitant disease. The average of hospital day was 10.6 days. The wound healing was good by chest CT at 1 month after the operation. Conclusion The sternal forming by the technique of the PM flap turnover, without remain of fremde stoffe in wound for DSWIs is distinctive method, evident effect.
作者
刘吉福
高永顺
李宝成
许笑彬
黄铄
LIU Jifu1,2, GAO Yongshun2, LI Baocheng1, XU Xiaobin1, HUANG Shuo1(1. Department of Thoracic Surgery, Emergency Medical Center of Integration of Traditional and Western Medicine of Beijing Chaoyang, Beijing, 100023, P.R.China 2. Department of Thoracic Surgery, Army General Hospital, Beijing, 100700, P.R.Chin)
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2018年第4期321-324,共4页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
胸骨切口深部感染
肌瓣成形
外科治疗
胸廓重建
Deep sternal wound infections
pectoralis major muscle flap
surgery
thoracic reconstruction
