重视胸骨切开术后胸骨深部伤口感染的预防和处理

官浩; 陈阳

doi:10.3760/cma.j.cn501225-20231212-00235

重视胸骨切开术后胸骨深部伤口感染的预防和处理

doi: 10.3760/cma.j.cn501225-20231212-00235

官浩^,,
陈阳

空军军医大学第一附属医院全军烧伤中心，烧伤与皮肤外科，西安　　710032

基金项目:

教育部中国高校产学研创新基金 2021JH030

详细信息

通讯作者:
官浩，Email：guanhao2020@yeah.net

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出版历程
- 收稿日期: 2023-12-12

Pay attention to the prevention and treatment of deep sternal wound infection after sternotomy

Guan Hao^,,
Chen Yang

Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China

Funds:

Industry-University-Research Innovation Fund of Ministry of Education of China 2021JH030

More Information

Corresponding author: Guan Hao, Email: guanhao2020@yeah.net

摘要

摘要: 胸骨深部伤口感染（DSWI）是心脏手术后潜在且灾难性的并发症之一。尽管临床上采用了更小的切口、常规预防性使用抗生素和优化血糖管理等措施，但DSWI的发病率依然在1%~5%波动。DSWI在发生初期的症状和体征均不明显，致使临床医师的干预介入偏晚。DSWI一旦未被及时处理，患者病死率极高。因此，及早预防、诊断和适当处理对于防止DSWI进一步发展至致命的结局非常重要。鉴于DSWI的临床危害性和治疗的复杂性，故本文重点探讨和分享在各个环节中预防DSWI发生的经验、发生后的重建修复策略，以引起广大同行对DSWI的重视。
- 胸骨切开术 /
- 外科伤口感染 /
- 纵隔炎 /
- 手术后并发症 /
- 胸骨深部伤口感染 /
- 预防和治疗 /
- 创面修复
Abstract: Deep sternal wound infection (DSWI) is one of the potential and catastrophic complications after cardiac surgery. Despite the use of smaller incisions, routine application of prophylactic antibiotic and optimized blood glucose management, the incidence rate of DSWI still fluctuates between 1% and 5%. The early symptoms and signs of DSWI are not often obvious, making it too late for the clinicians to intervene in the process. Once left untreated, DSWI carries a very high mortality rate. Therefore, early prevention, diagnosis, and appropriate management of DSWI are crucial in preventing its progression to life-threatening outcomes. Considering the clinical severity and treatment complexity of DSWI, this article focuses on preventive experiences in each stage of DSWI, and reconstructive strategies after DSWI happens, raising attention among the medical community regarding DSWI.
- Sternotomy /
- Surgical wound infection /
- Mediastinitis /
- Postoperative complications /
- Deep sternal wound infection /
- Prevention and treatment /
- Wound repair
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参考文献(26)

[1]	BurnettCM, RosemurgyAS, PfeifferEA. Life-threatening acute posterior mediastinitis due to esophageal perforation[J]. Ann Thorac Surg, 1990,49(6):979-983. DOI: 10.1016/0003-4975(90)90882-7.
[2]	JaworskyD, ReynoldsS, ChowAW. Extracranial head and neck infections[J]. Crit Care Clin, 2013,29(3):443-463. DOI: 10.1016/j.ccc.2013.03.003.
[3]	CherveniakovA, CherveniakovP. Surgical treatment of acute purulent mediastinitis[J]. Eur J Cardiothorac Surg, 1992,6(8):407-410; discussion 411. DOI: 10.1016/1010-7940(92)90064-5.
[4]	SongYY, ChuWL, SunJC, et al. Review on risk factors, classification, and treatment of sternal wound infection[J]. J Cardiothorac Surg, 2023,18(1):184. DOI: 10.1186/s13019-023-02228-y.
[5]	PhoonPHY, HwangNC. Deep sternal wound infection: diagnosis, treatment and prevention[J]. J Cardiothorac Vasc Anesth, 2020,34(6):1602-1613. DOI: 10.1053/j.jvca.2019.09.019.
[6]	ChanM, YusufE, GiulieriS, et al. A retrospective study of deep sternal wound infections: clinical and microbiological characteristics, treatment, and risk factors for complications[J]. Diagn Microbiol Infect Dis, 2016,84(3):261-265. DOI: 10.1016/j.diagmicrobio.2015.11.011.
[7]	BalachandranS, LeeA, DenehyL, et al. Risk factors for sternal complications after cardiac operations: a systematic review[J]. Ann Thorac Surg, 2016,102(6):2109-2117. DOI: 10.1016/j.athoracsur.2016.05.047.
[8]	KrasivskyiI, IvanovB, EghbalzadehK, et al. Sex-associated differences in short-term outcomes in patients with deep sternal wound infection after open-heart surgery[J]. J Clin Med, 2022,11(24):7510. DOI: 10.3390/jcm11247510.
[9]	PanL, MoR, ZhouQ, et al. Deep sternal wound infection after cardiac surgery in the Chinese population: a single-centre 15-year retrospective study[J]. J Thorac Dis, 2017,9(9):3031-3037. DOI: 10.21037/jtd.2017.08.41.
[10]	McGregorWE, TrumbleDR, MagovernJA. Mechanical analysis of midline sternotomy wound closure[J]. J Thorac Cardiovasc Surg, 1999,117(6):1144-1150. DOI: 10.1016/s0022-5223(99)70251-5.
[11]	TeppaR, SudeNS, KaranamVPK, et al. Relevance of subcutaneous fat thickness as a risk factor for surgical site infections in abdominal surgeries[J]. Cureus, 2022,14(1):e20946. DOI: 10.7759/cureus.20946.
[12]	MagalhãesDMS, DeiningerMO, OliveiraOG, et al. Deep sternal wound infection after beating heart coronary artery bypass surgery with routine use of skeletonized bilateral internal thoracic artery[J]. Braz J Cardiovasc Surg, 2023,38(4):e20210607. DOI: 10.21470/1678-9741-2021-0607.
[13]	SoferD, GurevitchJ, ShapiraI, et al. Sternal wound infections in patients after coronary artery bypass grafting using bilateral skeletonized internal mammary arteries[J]. Ann Surg, 1999,229(4):585-590. DOI: 10.1097/00000658-199904000-00020.
[14]	GattiG, PappalardoA, ChocronS, et al. Validation and performance comparison of two scoring systems created specifically to predict the risk of deep sternal wound infection after bilateral internal thoracic artery grafting[J]. Surg Infect (Larchmt), 2020,21(5):433-439. DOI: 10.1089/sur.2019.252.
[15]	JaiswalA, TrubyLK, ChichraA, et al. Impact of obesity on ventricular assist device outcomes[J]. J Card Fail, 2020,26(4):287-297. DOI: 10.1016/j.cardfail.2019.10.001.
[16]	VosRJ, Van PutteBP, KloppenburgGTL. Prevention of deep sternal wound infection in cardiac surgery: a literature review[J]. J Hosp Infect, 2018,100(4):411-420. DOI: 10.1016/j.jhin.2018.05.026.
[17]	KaulP. Sternal reconstruction after post-sternotomy mediastinitis[J]. J Cardiothorac Surg, 2017,12(1):94. DOI: 10.1186/s13019-017-0656-7.
[18]	LazarHL, SalmTV, EngelmanR, et al. Prevention and management of sternal wound infections[J]. J Thorac Cardiovasc Surg, 2016,152(4):962-972. DOI: 10.1016/j.jtcvs.2016.01.060.
[19]	LeeDY, EoS, LimS, et al. Successful pedicled vertical rectus abdominis myocutaneous flap reconstruction with negative-pressure wound therapy for deep sternal wound infection: a case report and comprehensive review[J]. Front Surg, 2023,10:1268555. DOI: 10.3389/fsurg.2023.1268555.
[20]	BotianuPVH. Current indications for the intrathoracic transposition of the omentum[J]. J Cardiothorac Surg, 2019,14(1):103. DOI: 10.1186/s13019-019-0924-9.
[21]	ErnertC, KielsteinH, AzatyanA, et al. Extended arc of rotation of Latissimus Dorsi Musculocutaneous Flap providing well-vascularized tissue for reconstruction of complete defects of the sternum: an anatomical study of flap pedicle modification[J/OL]. Clin Hemorheol Microcirc, 2023(2023-09-16)[2023-12-12]. https://pubmed.ncbi.nlm.nih.gov/37742631/.DOI: 10.3233/CH-238115.[published online ahead of print].
[22]	LoS, HutsonK, HallamMJ, et al. The importance of early flap coverage in deep sternal wounds[J]. Ann Plast Surg, 2014,73(5):588-590. DOI: 10.1097/SAP.0b013e318284084b.
[23]	CabbabeEB, CabbabeSW. Immediate versus delayed one-stage sternal débridement and pectoralis muscle flap reconstruction of deep sternal wound infections[J]. Plast Reconstr Surg, 2009,123(5):1490-1494. DOI: 10.1097/PRS.0b013e3181a205f9.
[24]	BanjanovicB, Haxibeqiri KarabicI, StrausS, et al. Our experiences in the treatment of anterior chest wall infections (2015-2021)[J]. Mater Sociomed, 2022,34(2):142-148. DOI: 10.5455/msm.2022.34.142-148.
[25]	van WingerdenJJ, UbbinkDT, van der HorstCM, et al. Poststernotomy mediastinitis: a classification to initiate and evaluate reconstructive management based on evidence from a structured review[J]. J Cardiothorac Surg, 2014,9:179. DOI: 10.1186/s13019-014-0179-4.
[26]	张万福, 徐婧, 张敬群, 等. 胸骨切开术后继发伴胸骨骨髓炎和/或纵隔炎创面的围手术期处理及其临床效果[J].中华烧伤与创面修复杂志,2024,40(2):151-158. DOI: 10.3760/cma.j.cn501225-20231028-00141.