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Management of sternal osteomyelitis and mediastinal infection following median sternotomy

Chinese Medical Journal 2010年第20期123卷 2803-2806页

作者： GAO Ju WANG You-li LU Shu-qiang CAI Ai-bing YANG Zhi-fu HAN Zhi-yi LI Jiu-jiang WEN Yu-ming GENG Feng-yong WANG Wen-zhang Third Department of Surgery Hospital of Aviation Industry Corporation of ChinaBeijing 100012China

Background median sternotomy is considered the most usually performed procedure in cardiac operations. This study aimed to assess clinical effectiveness of bilateral pectoralis major muscle flaps （BPMMF） for management of sternal osteomyelitis and mediastinal infection following median *** Clinical data were collected and retrospectively analyzed from twelve patients who underwent the BPMMF transposition for management of sternal osteomyelitis and mediastinal infection following median sternotomy from January 2006 to June 2009. Procedure consisted of rigorous debridement of necrotic tissues, dead space obliteration using the BPMMF, and placement of drainage tubes connected to a negative pressures generator for adequate *** No patients died of drainage, and all 12 patients had viable BPMMF when discharged from hospital. At 1 week post discharge, 2 patients presented with sternal infection but recovered following local debridement and medication. No patients showed infection recurrence during the follow-up period over 10 *** Sternal osteomyelitis and mediastinal infection following median sternotomy may be effectively managed through rigorous debridement of infected soft tissues, resection of the damaged stermal segment, transposition of the BPMMF to fill the damaged sternum resulting from debridement, and adequate postoperative drainage.

关键词： median sternotomy sternal osteomyelitis mediastinal infection muscle flaps management

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The effect of surgical skin tension reduction combined with early electronic line irradiation on keloid treatment after median sternotomy

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South China Journal of Cardiology 2017年第2期18卷 144-149页

作者：孙传伟黄志锋赖文卞徽宁吴敏郑少逸熊兵刘族安罗红敏马亮华李汉华李成志 Deparment of Burns and wound repair Surgery Department of Cardiology Guangdong General Hospital Guangdong Academy Medical Sciences Guangzhou 510080 Department of General Surgery The first people' s Hospital of Kashi region Kashgar 844000 China

Background median sternotomy remains the preferred technique in open heart surgery. The middle part of the chest is a predilection site for keloids. Keloids are often accompanied by itching and pain, and seriously affect the beauty and quality of life. The main treatments of keloids include surgical resection, local injection of drugs, laser, cryotherapy, compression therapy, and topical application of silica gel. Unfortunately, there is no way to achieve superior results. Therefore, there is a need to find an effective way to treat keloid after median sternoto- my. Our study was designed to investigate the effect of reducing the tension of the skin and the early electronic line irradiation on the treatment of keloid after median sternotomy. Methods A retrospective analysis was per- formed in 54 patients with keloid after median sternotomy treated by reducing the tension of the skin and remov- ing the keloid, followed with electron beam irradiation treatment 24 hours after the operation. For each patient, 5 Gy electron beam irradiation was used every day after the operation for 4 days with the total dose of 20 Gy. The patients were followed up at 6 months and 12 months after surgery. Results Fifty-four cases of patients were followed up for at least 6 months. In 6 months follow-up, there were significant effects in 34 cases with a total effective rate of 98.1%. In 12 months follow-up, 33 cases were cured with the total effective rate was 96.3%. Conclusion The treatment of keloid after median sternotomy can be achieved by the combination of tension re- duction surgery and early electronic line irradiation.

关键词： median sternotomy keloid electronic irradiation skin tension reduction surgery

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Comparison of straight median sternotomy and interlocking sternotomy with respect to biomechanical stability

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World Journal of Orthopedics 2013年第3期4卷 134-138页

作者： Fatih Kücükdurmaz Ismail Agir Murat Bezer Clinic of Orthopaedics and Traumatology Bezmialem Vakif UniversitySchool of MedicineIstanbul 34093Turkey Departments of Orthopaedics and Traumatology Adiyaman University School of MedicineAdiyaman 02040Turkey Departments of Orthopaedics and Traumatology Marmara University School of MedicinePendik 34899IstanbulTurkey

AIM: To increase the stability of sternotomy and so decrease the complications because of instability. METHODS: Tests were performed on 20 fresh sheep sterna which were isolated from the sterno-costa joints of the ribs. median straight and interlocking sternotomies were performed on 10 sterna each, set as groups 1 and 2, respectively. Both sternotomies were performed with an oscillating saw and closed at three points with a No. 5 straight stainless-stee wiring. Fatigue testing was performed in craniocaudal, anterio-posterior(AP) and lateral directions by a computerized materials-testing machine cycling between loads of 0 to 400 N per 5 s(0.2 Hz). The amount of displacement in AP, lateral and craniocaudal directions were measured and also the op-posing bone surface at the osteotomy areas were calculated at the two halves of sternum. RESULTS: The mean displacement in cranio-caudal direction was 9.66 ± 3.34 mm for median sternotomy and was 1.26 ± 0.97 mm for interlocking sternotomy, P median sternotomy and was 1.20 ± 0.55 mm for interlocking sternotomy, P median sternotomy and was 7.24 ± 2.43 mm for interlocking sternotomy, P > 0.001. The mean surface area was 10.40 ± 0.49 cm2 for median sternotomy and was 16.8 ± 0.78 cm2 for interlocking sternotomy, P sternotomy compared to median sternotomy. This method may provide better healing and less complication rates in clinical setting, further studies are necessary for its clinical implications.

关键词： median sternotomy Interlocking stenotomy Stability Osseos healing Biomechanics

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Deep Sternal Wound Infections after Coronary Artery Bypass Grafting: Analysis of 29 Cases from Iraq

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World Journal of Cardiovascular Surgery 2022年第7期12卷 153-172页

作者： Raghda Basil Ismael Alkhateeb Asmaa Saleem Esmail Ah-Ghurabi Laith Saleh Alkaaby Abdulsalam Y. Taha Department of Cardiac Surgery Slemani Cardiac Hospital Sulaymaniyah Iraq The Diabetes Center in Sulaymaniyah Sulaymaniyah Iraq Department of Cardiac Surgery Iraqi Center for Heart Diseases Baghdad Iraq Department of Thoracic and Cardiovascular Surgery College of Medicine University of Sulaimani Sulaymaniyah Iraq

Background: Deep sternal wound infection (DSWI), or mediastinitis, is a devastating complication of coronary artery bypass grafting (CABG). This prospective study aimed to assess our management of DSWI in view of the published literature. Methods: Over 2-years (ending in January 2016), 29 patients (20 males) developed DSWI amongst 520 patients who underwent standard CABG surgeries (5.6%). Pre-, intra- and postoperative variables were documented. Whenever possible, the infections were culture-verified. Besides antibiotics, patients received one or more of the following therapies: drainage, debridement, closed irrigation, sternal re-wiring, vacuum-assisted closure (VAC), and bone resection. Results: the male to female ratio was 2.2:1. Mean age was 58.1 ± 7.3 years. The mean body mass index (BMI) was 27.9 ± 3.4 kg/m2. There were 18, 16 and 11 patients with diabetes mellitus (DM), hypertension and chronic obstructive pulmonary disease (COPD) respectively. Cardiopulmonary bypass (CPB) was utilized in 26 (89.7%) patients with a mean time of 117.5 ± 23.3 minutes. Most surgeries (n = 21, 72.4%) lasted 5 - 6 hrs. According to Pairolero classification, there were 3 (10.3%) Type I, 22 (75.9%) Type II and 4 (13.8%) Type III infections. Four (13.8%) cases were culture-verified. Twenty-three (79.3%) DSWIs were surgically managed. Sternal re-wiring was performed in 14 (48.3%) cases while VAC was added to other therapies in 2 (6.9%) patients. DSWIs completely resolved in 18 (62.0%) patients within 3 - 24 weeks while two (6.9%) patients died within 30 days. Conclusion: We have identified six independent risk factors for DSWI (male gender, obesity, DM, hypertension, COPD and CPB), five of them are modifiable.

关键词： Deep Sternal Wound Infection Mediastinitis Coronary Artery Bypass Grafting median sternotomy Vacuum-Assisted Closure Wound Debridement

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