Deep Sternal Wound Infection after Median Sternotomy

正中胸骨切開術後的深部胸骨傷口感染

彭成康(Cherng-Kang Perng) ； 方榮煌(Rong-Hwuang Fang) ； 沈秉輝(Bing-Hwei Shen)

《中華民國重建整形外科醫學會雜誌》 8卷4期 (1999/12) Pp. 233-244

https://doi.org/10.7096/JPRSA.199912.0233

摘要

心臟血管手術之正中胸骨切開術後的深部胸骨傷口感染是少見但嚴重的併發症。雖然這種重要併發症的發生機率已經降低，但是死亡率仍然很高。深部胸骨傷口感染的早期診斷加上徹底清創和傷口的早期覆蓋是主要的治療方法。從一九九五年七月到一九九八年六月，在一千二百五十六個成年病患中有十二個病人被發現有胸骨正中切開術後的深部胸骨傷口感染，發生率是0.96%。發生深部胸骨傷口感染的獨立危險因子是早期再手術，肥胖，抽煙，和糖尿病。十一位病人接受立即的清創，胸骨再縫合及連續縱隔腔沖洗治療，其中二位復原，三位死亡，及六位持續感染。這六位病人的傷口再接受胸大肌皮瓣覆蓋之後，除了一位仍死於敗血症外，其餘的感染都受到良好的控制。連續縱隔腔沖洗治療的成功率為18.2%。連續縱隔腔沖洗治療失敗的病人接受胸大肌皮瓣治療的成功率是83.3%。深部胸骨傷口感染的死亡率在我們醫院是41.7%。使用徹底清創及連續縱隔腔沖洗來治療深部胸骨傷口感染有很高的失敗率。使用胸大肌皮瓣來覆蓋感染性的深部胸骨傷口能有效的控制感染且很少有遠期的併發症，或許可以考慮用來當作第一線的治療方法。

並列摘要

Deep sternal wound infection after median sternotomy for cardiovascular surgical procedures is a rare but serious complication. Although incidence of such major complication is reduced but mortality remains high. Early diagnosis of deep sternal wound infetion followed by extensive debridement and immediate or early wound coverage is the rational treament strategy. From July 1995 to June 1998, 12 patients with post-median sternotomy deep sternal wound infection are identified among 1256 adult patients with incidence of 0.96%. Independent risk factors for developing deep sternal wound infection are goin operation, BMI, smoking, and DM. 11 patients received immediate debridement, rewiring of sternum and continuous mediastinal irrigation treatment with 2 recovered, 3 died, and 6 persistent infection. The 6 patients' sternal wounds were then received pectoralis major muscle flap coverage and showed good infection control except one died due to persistent infection and evolved to sepsis. Success rate of continuous mediastinal irrigation management is 18.2%. With continuous irrigation treatment failed patients, successful salvage rate by pectoralis major muscle flap is 83.3%. Mortality rate of deep sternal wound infection in our series is 41.7%. Treatment of post-operative deep sternal wound infection by extensive debridement and continuous mediastinal irrigation associates with high failure rate.
Pectoralis major muscle flap closure of infected deep sternal wound is effective in infection control and with minimal long-term complications, and may be considered to be used as primary treatment of post-operative deep sternal wound infection.

並列關鍵字

mediastinitis ； sternal osteomyelitis ； continuous mediastinal irrigation ； pectoralis major muscle flap