Successful Treatment of Deep Sternal Wound Infection Combined Using Negative Pressure Wound Therapy, Artificial Dermis and Split-Thickness Skin Graft into Two-Stage Reconstructive Procedure - A Case Report

以合併負壓傷口治療、人工真皮及分層皮膚移植之兩階段式重建成功治療深部胸骨傷口感染－案例報告

黃惇暐(Dun-Wei Huang) ； 江奕翰(I-Han Chiang) ； 陳錫根(Shyi-Gen Chen) ； 王志信(Chih-Hsin Wang)

《臺灣整形外科醫學會雜誌》 28卷3期 (2019/09) Pp. 253-259

摘要

Background: Deep sternal wound infection (DSWI) are potentially life-threatening complications after open cardiac surgery because they can spread into the mediastinum and increase morbidity and mortality. Aim and Objectives: This case report presents alternative treatment of a deep sternal wound infection, with complete healing. Materials and Methods: We present a 79-year-old woman with a history of coronary artery bypass grafting (CABG). A deep sternal wound infection was present after surgery. A sternal defect was left after debridement. Using negative pressure wound therapy (NPWT) and artificial dermis, mesh reinforced type as the first stage procedure. After the wound was filled with granulation tissue, followed by coverage with a split-thickness skin graft (STSG) as second stage procedure. After 2 months of treatment and follow-up, the wound had healed completely without tissue loss or complications. Results: The wound was healed satisfactorily during a 2-month postoperative treatment and follow-up. Conclusion: Deep sternal wound infection (DSWI) can be alternatively treated by two-stage reconstructive procedure with artificial dermis, negative pressure wound therapy and split-thickness skin graft in patients with high risk of general anesthesia who cannot undergo major surgery.

關鍵字

deep sternal wound infection ； negative pressure wound treatment ； vacuum-assisted closure ； artificial dermis ； split-thickness skin graft

並列摘要

背景：深部胸骨傷口感染是開心手術術後一個威脅生命的併發症。因其感染可能會蔓延到縱隔腔，造成術後重大的後遺症，甚至是死亡。目的及目標：提出對於深部胸骨傷口感染的另一種使傷口癒合的治療方式。材料及方法：一位79歲女性在接受冠狀動脈繞道手術後發生深部胸骨傷口感染。雖然經過多次清創手術，但胸骨傷口仍然缺陷及癒合不良。我們使用了負壓傷口療法合併人工真皮進行第一階段治療，使肉芽組織漸漸的填滿傷口缺陷。再用分層皮膚移植覆蓋傷口作為第二階段治療。持續治療追蹤兩個月後，病人的傷口完全癒合，且沒有組織缺陷及感染的狀況發生。結果：在持續了兩個月的治療追蹤後，病患傷口癒合良好。結論：對於具有高麻醉風險，不適合進行重大手術之病患，以合併負壓傷口治療、人工真皮及分層皮膚移植之兩階段式重建來治療深部胸骨傷口感染，或許是另一種值得考慮的選擇。