Objective To analyze and summarize the clinical features and experience in surgical treatment of deep sternal infection (DSWI).Methods This was a retrospective study.From January 2008 to December 2013,189 patients with secondary DSWI after cardiac surgery underwent the pectoralis major muscle flap transposition in our department.There were 116 male and 73 female patients.The mean age was (54 ± 21) years,the body mass index was (26.1 ± 1.3) kg/m2.The incidence of postoperation DSWI were after isolated coronary artery bypass grafting (CABG) in 93 patients,after other heart surgery plus CABG in 13 patients,after valve surgery in 47 patients,after thoracic aortic surgery in 16 patients,after congenital heart disease in 18 patients,and after cardiac injury in 2 patients.Clean patients' wound and extract secretions,clear the infection thoroughly by surgery and select antibiotics based on susceptibility results,and then repair the wound with appropriate muscle flap,place drain tube with negative pressure.Of all the 189 patients,184 used isolate pectoralis,1 used isolate rectus,and 4 used pectoralis plus rectus.Results The operative wounds of 179 patients were primary healing (94.7％).Hospital discharge was postponed by 1 week for 7 patients,due to subcutaneous wound infection.Suhcutaneous wound infection occurred again in 8 patients 1 week after hospital discharge,and their wounds healed after wound dressing.Nine patients (4.7％) did not recover,due to residue of the sequestrum and costal chondritis,whom were later cured by undergoing a second treatment of debridement and pectoralis major muscle flap transposition.Eight patients died,in which 2 died of respiratory failure,2 died of bacterial endocarditis with septicemia,2 died of renal failure,1 died of intraoperative bleeding leading to brain death and the 1 died of heart failure.The mortality rate was 4.2％.The average length of postoperative hospital stay was (14 ± 5) days.The longest postoperative follow-up period was 40 months,the median time was 26 months,the follow-up rate was 83.9％.Totally 179 patients were no-reinfected,2 patients were reinfected because of artificial vascular rejection.Conclusion To perform surgical debridement and then reconstruct the sternal defect with pectoralis major muscle flap actively for the patient is an effective measure to improve patient's survival rate.%目的 总结心脏手术后深部胸骨切口感染(DSWI)的临床特点和外科治疗经验.方法 回顾性分析2008年1月至2013年12月中国医科大学航空总医院胸外科189例采用胸大肌肌瓣、腹直肌肌瓣手术治疗的心脏手术后DSWI患者的临床资料.其中男性116例,女性73例;平均年龄(54±21)岁,体重指数(26.1±1.3) kg/m2.单纯冠状动脉旁路移植术(CABG)93例,CABG同期行其他心脏手术13例,瓣膜置换术或成形术47例,主动脉手术16例,先天性心脏病18例,心脏外伤2例.患者入院后给予清洁感染创面并提取分泌物,依据分泌物药敏结果选取抗生素抗感染治疗,手术扩大清创彻底清除感染灶,根据清创缺损情况选择肌瓣填充修复,其中单纯应用胸大肌肌瓣184例、单纯腹直肌肌瓣1例,胸大肌联合腹直肌肌瓣4例,放置负压吸引装置引流,定期换药理疗.结果 179例术后2周内康复出院,伤口一期愈合率94.7％;7例患者因切口皮下感染延迟1周出院,3例院内死亡.术后平均住院时间(14±5)d.8例患者出院1周后出现皮下脂肪液化经换药后伤口痊愈,9例因死骨残留等原因出院2个月后伤口再次出现窦道经再次清创肌瓣修复而治愈.死亡8例,病死率4.2％,其中6例死于感染相关并发症.术后随访1 ～ 40个月,中位随访时间26个月,随访率83.9％.149例患者无感染复发,2例因主动脉置换术后人工血管排斥,虽然经过一次清创及肌瓣移植仍残留窦道.结论 心脏大血管手术后DSWI应积极行外科手术清创,胸大肌肌瓣和(或)腹直肌肌瓣修复重建胸骨缺损区域是DSWI的有效治疗方法.
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