留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

抗菌可吸收缝线拉拢闭合术修复正中开胸术后因胸骨深部伤口感染致小范围骨缺损创面的效果

李汉华 熊兵 刘族安 黄志锋 孙传伟 罗红敏 马亮华 卞徽宁 郑少逸 赖文

李汉华, 熊兵, 刘族安, 等. 抗菌可吸收缝线拉拢闭合术修复正中开胸术后因胸骨深部伤口感染致小范围骨缺损创面的效果[J]. 中华烧伤与创面修复杂志, 2024, 40(5): 461-467. DOI: 10.3760/cma.j.cn501225-20231103-00178.
引用本文: 李汉华, 熊兵, 刘族安, 等. 抗菌可吸收缝线拉拢闭合术修复正中开胸术后因胸骨深部伤口感染致小范围骨缺损创面的效果[J]. 中华烧伤与创面修复杂志, 2024, 40(5): 461-467. DOI: 10.3760/cma.j.cn501225-20231103-00178.
Li HH,Xiong B,Liu ZA,et al.Effects of antibacterial absorbable suture closure in the repair of small range of bone defect wounds due to deep sternal wound infection after median thoracotomy[J].Chin J Burns Wounds,2024,40(5):461-467.DOI: 10.3760/cma.j.cn501225-20231103-00178.
Citation: Li HH,Xiong B,Liu ZA,et al.Effects of antibacterial absorbable suture closure in the repair of small range of bone defect wounds due to deep sternal wound infection after median thoracotomy[J].Chin J Burns Wounds,2024,40(5):461-467.DOI: 10.3760/cma.j.cn501225-20231103-00178.

抗菌可吸收缝线拉拢闭合术修复正中开胸术后因胸骨深部伤口感染致小范围骨缺损创面的效果

doi: 10.3760/cma.j.cn501225-20231103-00178
基金项目: 

广东省基础与应用基础研究区域联合基金重点项目 2020B1515120088

广州市科技基础与应用基础研究项目 202102080323

详细信息
    通讯作者:

    赖文,Email:Laiwencn@msn.com

Effects of antibacterial absorbable suture closure in the repair of small range of bone defect wounds due to deep sternal wound infection after median thoracotomy

Funds: 

Key Project of Guangdong Basic and Applied Basic Research Foundation 2020B1515120088

Basic and Applied Research of Science and Technology Project of Guangzhou 202102080323

More Information
  • 摘要:   目的  探讨采用抗菌可吸收缝线拉拢闭合术修复正中开胸术后因胸骨深部伤口感染致小范围骨缺损创面的效果。  方法  该研究为回顾性非随机临床对照研究。将2017年10月—2021年12月南方医科大学附属广东省人民医院(以下简称本院)收治的32例[男20例、女12例,年龄(58±11)岁]符合入选标准且实施抗菌可吸收缝线拉拢闭合术(以下简称直接闭合术)的患者纳入直接闭合组,将2015年1月—2020年1月本院收治的39例[男27例、女12例,年龄(59±11)岁]符合入选标准且实施双侧胸大肌肌瓣填塞修复术的患者纳入肌瓣填塞组。Ⅰ期对胸骨感染创面彻底清创后行Ⅱ期创面修复术。2组患者清创后的胸骨横截面缺损宽度均<1 cm。直接闭合组患者的Ⅱ期创面修复术为采用双线间断缝合胸骨前板或胸骨全层6处或7处。统计2组患者Ⅱ期创面修复术的时长及术中出血量、住院时间以及创面感染细菌情况。统计2组患者术后并发症情况及创面愈合情况。随访时,观察2组患者创面是否存在感染或复发情况以及直接闭合组患者胸骨愈合情况。  结果  与肌瓣填塞组相比,直接闭合组患者Ⅱ期创面修复术的时长和住院时间均明显缩短(t值分别为13.61、6.25,P<0.05)、Ⅱ期创面修复术的术中出血量无明显变化(P>0.05)。2组患者感染的细菌以葡萄球菌为主。直接闭合组中1例患者术后2周创面处有渗液,经保守换药治疗2周后创面愈合良好;其余患者创面均愈合良好。肌瓣填塞组中5例患者出现术后并发症,其中1例患者死亡、4例患者创面经换药或再次手术后愈合;其余患者创面均愈合良好。2组患者并发症发生情况比较,差异无统计学意义(P>0.05)。随访22~45个月,直接闭合组患者与肌瓣填塞组存活患者创面均未见再次感染或复发。直接闭合组患者胸骨均达到解剖愈合。  结论  直接闭合术不仅能在早期有效修复正中开胸术后因胸骨深部伤口感染致胸骨横截面缺损宽度<1 cm的创面,而且能显著缩短患者的手术时长和住院时间。

     

  • 参考文献(25)

    [1] 官浩, 陈阳. 重视胸骨切开术后胸骨深部伤口感染的预防和处理[J]. 中华烧伤与创面修复杂志, 2024, 40(2): 125-130. DOI: 10.3760/cma.j.cn501225-20231212-00235.
    [2] ZukowskaA, ZukowskiM. Surgical site infection in cardiac surgery[J]. J Clin Med, 2022,11(23):6991. DOI: 10.3390/jcm11236991.
    [3] Perezgrovas-OlariaR, AudisioK, CancelliG, et al. Deep sternal wound infection and mortality in cardiac surgery: a meta-analysis[J]. Ann Thorac Surg, 2023,115(1):272-280. DOI: 10.1016/j.athoracsur.2022.04.054.
    [4] FinkelsteinR, RabinoG, MashiahT, et al. Surgical site infection rates following cardiac surgery: the impact of a 6-year infection control program[J]. Am J Infect Control, 2005,33(8):450-454. DOI: 10.1016/j.ajic.2005.07.002.
    [5] OlsenMA, Lock-BuckleyP, HopkinsD, et al. The risk factors for deep and superficial chest surgical-site infections after coronary artery bypass graft surgery are different[J]. J Thorac Cardiovasc Surg, 2002,124(1):136-145. DOI: 10.1067/mtc.2002.122306.
    [6] LuJC, GraysonAD, JhaP, et al. Risk factors for sternal wound infection and mid-term survival following coronary artery bypass surgery[J]. Eur J Cardiothorac Surg, 2003,23(6):943-949. DOI: 10.1016/s1010-7940(03)00137-4.
    [7] SchimmerC, ReentsW, BernederS, et al. Prevention of sternal dehiscence and infection in high-risk patients: a prospective randomized multicenter trial[J]. Ann Thorac Surg, 2008,86(6):1897-1904. DOI: 10.1016/j.athoracsur.2008.08.071.
    [8] SinghK, AndersonE, HarperJG. Overview and management of sternal wound infection[J]. Semin Plast Surg, 2011,25(1):25-33. DOI: 10.1055/s-0031-1275168.
    [9] KaspersenAE, NielsenSJ, OrrasonAW, et al. Short- and long-term mortality after deep sternal wound infection following cardiac surgery: experiences from SWEDEHEART[J]. Eur J Cardiothorac Surg, 2021,60(2):233-241. DOI: 10.1093/ejcts/ezab080.
    [10] SamoukovicG, BernierPL, LachapelleK. Successful treatment of infected ascending aortic prosthesis by omental wrapping without graft removal[J]. Ann Thorac Surg, 2008,86(1):287-289. DOI: 10.1016/j.athoracsur.2008.01.086.
    [11] 郑少逸, 赖文, 黄志锋, 等. 双侧胸大肌肌瓣治疗开胸术后胸骨骨髓炎临床效果[J].中华烧伤杂志,2015,31(1):61-63. DOI: 10.3760/cma.j.issn.1009-2587.2015.01.016.
    [12] BrownRH, SharabiSE, KaniaKE, et al. The split pectoralis flap: combining the benefits of pectoralis major advancement and turnover techniques in one flap[J]. Plast Reconstr Surg, 2017,139(6):1474-1477. DOI: 10.1097/PRS.0000000000003328.
    [13] SpartalisE, MarkakisC, MorisD, et al. Results of the modified bi-pectoral muscle flap procedure for post-sternotomy deep wound infection[J]. Surg Today, 2016,46(4):460-465. DOI: 10.1007/s00595-015-1192-5.
    [14] KamelGN, JacobsonJ, RizzoAM, et al. Analysis of immediate versus delayed sternal reconstruction with pectoralis major advancement versus turnover muscle flaps[J]. J Reconstr Microsurg, 2019,35(8):602-608. DOI: 10.1055/s-0039-1688760.
    [15] BotaO, JostenC, BorgerMA, et al. Standardized musculocutaneous flap for the coverage of deep sternal wounds after cardiac surgery[J]. Ann Thorac Surg, 2019,107(3):802-808. DOI: 10.1016/j.athoracsur.2018.09.017.
    [16] DavisonSP, ClemensMW, ArmstrongD, et al. Sternotomy wounds: rectus flap versus modified pectoral reconstruction[J]. Plast Reconstr Surg, 2007,120(4):929-934. DOI: 10.1097/01.prs.0000253443.09780.0f.
    [17] GeorgiouI, IoannouCI, SchmidtJ, et al. Free flaps in sternal osteomyelitis after median sternotomy: a center's 12-year experience[J]. J Reconstr Microsurg, 2023,39(8):601-615. DOI: 10.1055/s-0043-1761208.
    [18] MarzoukM, BaillotR, KalavrouziotisD, et al. Early to midterm survival of patients with deep sternal wound infection managed with laparoscopically harvested omentum[J]. J Card Surg, 2021,36(11):4083-4089. DOI: 10.1111/jocs.15955.
    [19] Lo TortoF, TurrizianiG, DonatoC, et al. Deep sternal wound infection following cardiac surgery: a comparison of the monolateral with the bilateral pectoralis major flaps[J]. Int Wound J, 2020,17(3):683-691. DOI: 10.1111/iwj.13324.
    [20] EpsteinAE, AlexanderJC, GuttermanDD, et al. Anticoagulation: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery[J]. Chest, 2005,128(2 Suppl):24S-27S. DOI: 10.1378/chest.128.2_suppl.24s.
    [21] LiòP, PaolettiN, MoniMA, et al. Modelling osteomyelitis[J]. BMC Bioinformatics, 2012,14(Suppl 14):S12. DOI: 10.1186/1471-2105-13-S14-S12.
    [22] Gómez-AlonsoA, García-CriadoFJ, Parreño-ManchadoFC, et al. Study of the efficacy of Coated VICRYL Plus Antibacterial suture (coated Polyglactin 910 suture with Triclosan) in two animal models of general surgery[J]. J Infect, 2007,54(1):82-88. DOI: 10.1016/j.jinf.2006.01.008.
    [23] AbiriA, PaydarO, TaoA, et al. Tensile strength and failure load of sutures for robotic surgery[J]. Surg Endosc, 2017,31(8):3258-3270. DOI: 10.1007/s00464-016-5356-1.
    [24] GrossiEA, CullifordAT, KriegerKH, et al. A survey of 77 major infectious complications of median sternotomy: a review of 7,949 consecutive operative procedures[J]. Ann Thorac Surg, 1985,40(3):214-223. DOI: 10.1016/s0003-4975(10)60030-6.
    [25] 郑少逸, 陈华德, 孙传伟, 等. 开胸术后胸部正中难愈性伤口的临床分级及治疗[J].中国修复重建外科杂志,2014,28(9):1120-1124. DOI: 10.7507/1002-1892.20140244.
  • 1  采用抗菌可吸收缝线拉拢闭合术修复正中开胸术后因胸骨深部伤口感染致小范围骨缺损患者创面的效果。1A.彻底清创后,胸骨横截面出现骨缺损;1B.双线间断缝合胸骨7处;1C.在胸骨后留置引流管,缝线打结拉拢并固定胸骨;1D.术后12个月随访,切口愈合良好

    2  用于正中开胸术后因胸骨深部伤口感染致小范围骨缺损创面修复的抗菌可吸收缝线拉拢闭合术前及术后CT成像图。2A、2B.分别为术前和术后12个月的胸部CT三维重建图;2C、2D.分别为术前和术后12个月的胸部CT平面图,可见术前胸骨开裂伴有骨质缺损且骨密度低,术后胸骨已达解剖愈合

    表1  2组正中开胸术后因胸骨深部伤口感染(DSWI)致小范围骨缺损创面患者的临床资料比较

    表1.   Comparison of clinical data between the two groups of patients with small range of bone defect wounds due to deep sternal wound infection (DSWI) after median thoracotomy

    组别例数性别(例)年龄(岁,x¯±s心脏手术类型(例)体重指数(kg/m2x¯±s正中开胸术至确诊DSWI时间(d,x¯±s糖尿病(例)
    大血管置换术冠脉搭桥术单纯换瓣术
    直接闭合组32201258±111091321.9±2.824±81220
    肌瓣填塞组39271259±115122223.2±3.027±141128
    统计量值χ2=0.36t=0.68χ2=3.76t=1.82t=0.93χ2=0.69
    P0.6190.4970.1530.0750.3790.452
    注:采用抗菌可吸收缝线拉拢闭合术、双侧胸大肌肌瓣填塞修复术分别修复直接闭合组、肌瓣填塞组患者创面
    下载: 导出CSV

    表2  2组正中开胸术后因胸骨深部伤口感染致小范围骨缺损创面患者评价指标比较

    表2.   Comparison of evaluation indexes between the two groups of patients with small range of bone defect wounds due to deep sternal wound infection after median thoracotomy

    组别例数手术时长(min,x¯±s手术术中出血量(mL,x¯±s住院时间(d,x¯±s并发症(例)
    直接闭合组3299±15121±7020±5131
    肌瓣填塞组39165±25140±7937±17534
    t13.611.086.25
    P<0.0010.291<0.0010.213
    注:采用抗菌可吸收缝线拉拢闭合术、双侧胸大肌肌瓣填塞修复术分别修复直接闭合组、肌瓣填塞组患者创面;手术指Ⅱ期创面修复术;“—”表示无此统计量值
    下载: 导出CSV
  • 加载中
图(3) / 表(2)
计量
  • 文章访问数:  112
  • HTML全文浏览量:  26
  • PDF下载量:  18
  • 被引次数: 0
出版历程
  • 收稿日期:  2023-11-03

目录

    /

    返回文章
    返回