Objective To investigate surgical strategies using bilateral pectoralis major muscle flaps for the treatment of sternal dehiscence after cardiac surgery. Methods From May 2005 to October 2010，21 patients with sternal dehiscence, sternal osteomyelitis and mediastinitis after cardiac surgery were admitted to Beijing An Zhen Hospital of Capital Medical University. There were 13 male patients and 8 female patients with their age of 53-72 （64.5±7.8） years. There were 19 patients after coronary artery bypass grafting （CABG） and 2 patients after heart valve replacement. The non-viable and necrotic bones were debrided and sternal wires partially or completely removed. The sternal origins of pectoralis major were released on both sides. The pectoralis major muscle flaps were tensionlessly sutured across medially over the sternal defect. Multiple suction drains were placed and removed in due time. The skin was intermittently closed. Results All the pectoralis major muscle flaps lived well after surgery，and all the patients were discharged in 2 weeks after surgery. Twenty patients were discharged with complete wound closure，and 1 patient had wound fistula and infection after removal of suction drains that was healed after another surgery to resect the wound fistula. During 6 month follow-up，sternal wound healed well in all the patients with normal thoracic appearance，and none of the patients had abnormal respiratory movement, infection recurrence or persistent infection. Conclusion Bilateral pectoralis major muscle flap technique is a positive and efficient surgical strategy for the treatment of refractory sternal dehiscence after cardiac surgery.
ObjectiveTo summarize surgical experience and explore the best treatment strategy for the management of complicated mediastinitis after cardiac surgery. MethodsClinical data of 18 patients who received vascularized muscle flap transposition combined with negative pressure wound therapy (NPWT)for the treatment of complicated mediastinitis after cardiac surgery in one stage in the Department of Cardiac Surgery of Beijing Anzhen Hospital, Capital Medical University between June 2006 and December 2012 were retrospective analyzed. There were 12 male and 6 female patients with their average age of 65.5±8.2 years. The average interval between cardiac surgery and vascularized muscle flap reconstruction was 12.5±5.8 days. ResultsPostoperatively, 1 patient died of recurrent mediastinitis, sepsis and multiple organ dysfunction syndrome. Seventeen patients had an uneventful postoperative recovery and one-stage wound healing. Postoperative hospital stay was 18.6±7.2 days and wound healing time was 4.5±2.4 weeks. All the 17 patients were followed up for over 6 months, no recurrent mediastinitis was observed, and they had a good quality of life. ConclusionVascularized muscle flap transposition combined with NPWT is a simple and effective surgical strategy for the treatment of complicated mediastinitis after cardiac surgery in one-stage.
目的通过改良Robicsek法胸骨固定及双侧胸大肌内侧头转移在非体外循环冠状动脉旁路移植术（OPCAB）患者胸骨固定中的应用，探讨此技术在预防OPCAB术后胸骨并发症的作用。 方法回顾性分析2011年2月至2013年4月北京安贞医院46例符合高危人群指征的心脏病患者行改良Robicsek法胸骨固定及双侧胸大肌内侧头转移手术的临床资料。男17例，女29例；年龄63～82（68.6±4.6）岁。 结果46例患者手术过程顺利，无1例发生胸骨并发症。1例死于围手术期心肌梗死、左心力衰竭，其余患者术后肌瓣存活良好。45例术后14 d拆线，伤口愈合良好。所有患者出院后1个月、6个月进行随访，皮肤切口愈合良好，胸骨固定良好，无窦道形成，未见反常呼吸运动，胸廓外形良好。 结论相对于传统闭合切口的方法，对可能发生胸骨合并症的高危人群，采用改良Robicsek法胸骨固定及双侧胸大肌内侧头转移术有一定的优势，能降低胸骨裂开及切口感染的概率，从而降低全身感染的概率，缩短患者康复时间，减轻心理压力。