Management of the Infected Sternotomy Wound

胸骨切開術後的傷口感染之處理

蔡秉諺(Ping-Yen Tsai) ； 孫一峰(I-Feng Sun) ； 李書欣(Su-Shin Lee) ； 邱肇基(Chaw-Chi Chiu) ； 林幸道(Sin-Daw Lin) ； 賴春生(Chung-Sheng Lai)

《中華民國整形外科醫學會雜誌》 18卷1期 (2009/03) Pp. 1-9

https://doi.org/10.7096/JPSA.200903.0001

摘要

胸骨骨髓炎是心臟手術後一個潛在致命性的併發症。感染能夠漫延至縱膈腔，影響到人工瓣膜或
血管、繞道之血管及縫合處。這可能是造成併發症及死亡的原因。
目的：
局部負壓傷口治療、肌肉皮瓣及高壓氧治療都已被證實對胸骨傷口癒合有效。我們希望利用這些方法來改善棘手的胸骨傷口感染而達到治療效果。
材料及方法：
自2005年1月至2008年1月，12名胸骨傷口感染之病人於高雄醫學大學附設中和紀念醫院治療。所有的傷口都接受清創手術、沖洗及局部負壓傷口治療。7名病人接受胸大肌肌肉皮瓣覆蓋。3名病人接受腹直肌皮膚肌肉皮瓣覆蓋。4名病人接受高壓氧治療。
結果：
所有的病人在接受皮瓣覆蓋或傷口癒合前都接受1至3次之清創手術。2名病人接受高壓氧治療但無皮瓣重建。經過以上處置，感染得到控制而且傷口癒合。在追蹤期間並無胸骨骨髓炎的復發。
結論：
(1)局部負壓傷口治療能提供數項優點使傷口適合重建。(2)根據傷口的解剖位置，我們能夠選擇適合的肌肉皮瓣來進行胸壁之重建。(3)高壓氧治療對困難的胸壁傷口是一個相當好的替代治療方法。

並列摘要

Background:
Sternal osteomyelitis is a potentially life-threatening complication after cardiac surgery. The infection can spread into the mediastinum, involving the prosthetic valve, grafts, and suture lines. It may be the cause of postoperative morbidity and mortality.
Aim and Objectives:
Topical negative pressure (TNP) dressing, muscle flap and hyperbaric oxygen therapy (HBO) have been proved to be effective for sternal wound healing. We want to take advantages of these methods to improve the results of intractable sternal wound infection.
Materials and methods:
From January 2005 to January 2008, 12 patients with sternal wound infection were treated at Kaohsiung Medical University Chung-Ho Memorial Hospital. All wounds received extensive debridement, irrigation, and TNP dressing. Seven patients received pectoralis major (PM) muscle flap coverage. Three patients accepted rectus abdominis myocutaneous (RAM) flaps coverage. Four patients received HBO therapy.
Results:
These patients received 1-3 times debridement before flap reconstruction or wound healed. Two patients did not receive any muscle flap for reconstruction after HBO management. After management, the infections were controlled and the wounds healed. There was no recurrence of sternal osteomyelitis during the follow-up periods.
Conclusions:
(1) The TNP dressing can apply several advantages to make the wound bed suitable for reconstruction. (2) According to the anatomic site of wound, we can choose proper muscle flap for sternal wall reconstruction. (3) The HBO therapy can be an alternative and inexpensive method for the difficult sternal wound infection patient.

並列關鍵字

sternal osteomyelitis ； topical negative pressure dressing ； muscle flap ； hyperbaric oxygen