胸骨正中切口术后胸骨骨髓炎及纵隔感染的修复重建  

Reconstruction for poststernotomy sternal osteomyelitis and mediastinitis follow median sternotomy

作　　者：王文璋 高举[1] 王幼黎[1] 蔡爱兵[1] 高永顺[2] 

机构地区：[1]航空总医院胸外科,100012 [2]北京军区总医院胸外科

出　　处：《心肺血管病杂志》2011年第5期418-419,共2页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨应用胸大肌肌瓣转移,修复重建治疗经胸骨正中切口术后,胸骨骨髓炎及纵隔感染的临床疗效。方法:回顾性分析我科自2008年1月至2011年4月,应用胸大肌肌瓣转移手术治疗58例胸骨正中切口,术后胸骨骨髓炎及纵隔感染患者的临床资料。手术方法为彻底清创,用转移的胸大肌肌瓣将胸骨缺损区填实消灭残腔,放置带负压吸引装置的引流管,保障伤口引流通畅。结果:58例患者肌瓣成活良好,52例2 w内康复出院。4例患者因切口皮下感染延迟1 w出院,2例患者出院后1 w再次出现伤口皮下感染,经局部清创、换药后伤口痊愈。所有患者经随访无感染复发。结论:手术彻底清除感染的软组织,咬除感染的胸骨,应用胸大肌肌瓣转移来填充清创后的胸骨缺损区,术后伤口充分引流,是治疗经胸骨正中切口手术术后胸骨骨髓炎及纵隔感染的有效方法。Objective：To evaluate the clinical effect of debridement and thoracic reconstruction as surgical treatment for sternal osteomyelitis and mediastinitis after sternotomy.Methods：The surgical procedures,clinical results and follow-up of 58 cases of poststernotomy sternal osteomyelitis and mediastinitis those underwent debridement and thoracic reconstruction with pectoralis major muscle flaps from January 2008 to April 2011 were analyzed retrospectively.Results：All 58 muscle flaps remained alive.52 patients recovered and discharged in 2 weeks,4 patients were discharged in 4 weeks for infection.2 patients presented subcutaneous infection at 1 week post discharge,but recovered following local debridement and medication.No patients showed subcutaneous infection recurrence during the follow-up period.Conclusion：Debridement and thoracic reconstruction with pectoralis major muscle flap are safe and effective in the treatment of poststernotomy sternal osteomyelitis and mediastinitis.

关 键 词：胸骨正中切口 胸骨骨髓炎 修复重建 

分 类 号：R56[医药卫生—呼吸系统]