Objective To investigate the therapeutic effectof infected incision wounds after sternotomy by using different reconstructive methods. Methods From December 1997 to December 2006, 13 patients (8 males, 5 females; age, 28-72 years averaged 52 years) with infected incision wounds after sternotomy underwent the reconstruction surgery respectivelyusing the pectoralis major muscle flaps, the medial flaps of the pectoralis major muscle, the rectus abdominis muscle flaps or the greater omentum transpositions. Among the patients, 8 were complicated by diabetes mellitus, 4 by pneumonia and heart failure, 3 by empyema, 4 by chronic insufficiency of the pulmonary function, 1 by malignant tumor, and 6 by severe obesity. Freshlysplit wounds werefound in 11 patients and chronic wounds in the other 2 patients.The size of thewounds was 10cm×5cm-22cm×10cm. Results Among the 13 patients，10 survived after operation and the other 3 died of massive hemorrhage from the anastomostic rupture of the blood vessel, pneumonia, and cancer metastasis, respectively. Of the 10 patients, 6 had their wounds healed by first intention. The follow-up for 6 months to 5 years revealed that there was no recurrencein all the survived patients. Of the 10 patients, 2 developed partial necrosisof the skins at the sutured wounds, which was healed after the skin grafting operation; 2 had an infection at the drainage area but had a healing after the dressing changes. Conclusion The smaller wounds in the upper partof the sternotomy incision should be repaired with the medial flaps of the pectoralis major muscle; the greater wounds in the upper part of the incision shouldbe repaired and reconstructed with the rectus abdominis muscle flap; the smaller wounds in the lower part of the incision should be repaired with the pectoralis major muscle flap, and if the wounds are longer, they should be repaired and reconstructed with the pectoralis major muscle flap and the rectus abdominis muscle flap; and if the wounds are huge enough with an exposure of the important internal organs, the greater omentum transposition should be used, and the residual wounds should be treated with dressing changes and even skin grafting.
ObjectiveTo evaluate the efficacy and safety of all kinds of hemocoagulase on operative incisions. MethodsDatabases including Web of Science, MEDLINE, EMbase, EBSCO, PubMed, CNKI, WanFang Data and VIP were electronically searched to collect randomized controlled trials (RCTs) about hemocoagulase on operative incisions from the inception to June 20th, 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.2 software. ResultsA total of 16 RCTs involving 1 867 patients were included. The results of meta-analysis showed that, compared with the control group, the hemostatic time (MD=-37.84, 95%CI -52.72 to -22.96, P<0.000 01), blood loss volume per unit area (MD=-0.09, 95%CI -0.10 to -0.07, P<0.000 01), PT of the first postoperative day (MD=-0.37, 95%CI -0.65 to -0.09, P=0.009) were significantly shorter in the hemocoagulase group. However, no significant differences were found in APTT, TT and FIB between two groups. ConclusionHemocoagulase can reduce hemostatic time and blood loss volume in surgical incisions. Due to the limited quantity and quality of the included studies, the above conclusion needs to be further verified by more high quality studies.