근육편에 의한 정중 흉골절개 감염의 치료 -5례 치험-

Management of Infected Median Sternotomy Wound by Muscle Flap -5 cases-

  • 발행 : 1994.07.01

초록

Infection of a median sternotomy incision may result in a large, unsightly,unstable,and potentially fatal wound. During the past 8 years, 5 consecutive patients [ 4 male and 1 female ] had repair of infected sternotomy wound. We describe our current preferred techniques and the results we have achieved with them. As soon as the sternal infection was shown, operative wound was opened and irrigated more than 4 times a day with 0.5% Betadine iodine solution until the exudate became clean with no growth of bacteria. Operation was performed in one-stage, which consisted of aggressive debridement of the infected bone and muscle transposition. Reconstruction was with one-side or both pectoralis flaps in all patients and rectus abdominis in 2 patients. There was no mortality or morbidity within 30 days postoperatively. We conclude that early aggressive debridement and muscle transposition remain the treatment of choice for most patients with infected median sternotomy wounds.

키워드

참고문헌

  1. J Thorac Cardiovasc Surg v.58 Complications of median sternotomy Brown,A.H.;Brainbridge,M.V.
  2. Arch surg v.83 Continuous antibiotic irrigation in the treatment of infection Shumaker,H.B.;Mandelbaum,I.
  3. Ann Surg v.191 Infected median sternotomy wounds. Successful treament by muscle flaps Jurkiewicz,M.J.;Bostwick,J.Ⅲ.;Hester,T.R.(et al.)
  4. J Thorac Cardiovasc Surg v.72 Sternal and costochondral infections following open-heart surgery. A review of 2,594 cases Culliford,A.T.;Cunningham,Jn.Jr.;Zeff,R.H.;Isom,O.W.;Teiko,P.;Spencer,F.C.
  5. J Thorac Cardiovasc Surg v.80 Sternal wound complications. Management and results Serry,C.;Bleck,P.C.Javid,H.(et al.)
  6. J Thorac Cardiovasc Surg v.63 Complications associated with median sternotomy Sanfelippo,P.M.;Danielson,G.K.
  7. J Thorac Cardiovasc Surg v.73 Management of an infected Hancock prosthesis after repair of truncus arteriosus Mosely,P.W.;Ochsner,J.L.;Mills,N.L.;Chapman,J.
  8. Arch Surg v.107 Mediastinitis following open-heart surgery. Review of two years' experience Engelman,R.M.;Williams,C.D.;Gouge,T.H.(et al.)
  9. J Thorac Cardiovasc Surg v.88 Management of recalcitrant median sternotomy wounds Pairolero,P.C.;Arnold,P.G
  10. Cardiac surgery(2nd ed.) Infection following cardiopulmonary bypass Amoury,R.A.;J.C.Norman
  11. Ann Surg v.169 Treatment of median sternotomy infection by mediastinal irrigation with an antibiotic solution Bryant,L.R.;Spencer,F.C.;Trinkle,J.K.
  12. Plast Reconstr Surg v.63 Use of pectoralis major muscle flaps to repair defects of anterior chest wall Arnold,P.G.;Pairolero,P.C.
  13. Ann Plast Surg v.22 The management of infected median sternotomy wounds Martin,R.D.
  14. Complications in cardiothoracic surgery(1st ed.) Management of postcardiotomy mediastinitis Craver,J.M.;Rand,R.D.;BostwickⅢ,J.; Harcher,C.R.;Waldhausen,J.A.;Orringer,M.B.