摘要
目的探讨开胸术后胸部正中难愈性伤口外科分级标准及对应治疗方法选择。方法2008年7月-2014年1月，收治260例开胸术后胸部正中难愈性伤口患者。男124例，女136例；年龄11～75岁，平均49．5岁。伤口形成时间13～365d，平均26．6d。伤口长度1～25cm，平均13．4cm。根据自定开胸术后难愈性伤口外科分级标准，Ⅰ级70例、Ⅱ级64例、Ⅲ级42例、Ⅳ级78例、Ⅴ级6例。扩创后Ⅰ、Ⅱ级伤口采用邻近皮瓣修复；Ⅲ级伤口采用蝶形胸骨固定器固定联合邻近皮瓣（28例）或双侧胸大肌推进修复（11例）以及双侧胸大肌推进修复（3例）；Ⅳ级伤口采用双侧胸大肌推进修复（65例）、腹直肌翻转修复（5例）以及带蒂大网膜瓣修复（8例）；Ⅴ级患者均采用带蒂大网膜瓣修复。结果患者均顺利完成手术。术后3例患者死亡，其中Ⅳ级1例、Ⅴ级2例，均为带蒂大网膜瓣修复者。患者住院时间4～86d，平均18．3d。伤口Ⅰ期愈合248例（96．5％）；9例愈合不良，其中8例行2次手术后愈合，1例经3次手术后愈合。结论自定开胸术后难愈性伤口外科分级标准适用于所有开胸术后胸部正中难愈性伤口，根据分级结果选择恰当治疗方法，可获得较好疗效。
Objective To define the classification of sternal wound complications after cardiac surgery and to explore the appropriate surgical treatment. Methods Between July 2008 and January 2014, 260 patients with sternal wound complications after cardiac surgery were treated. There were 124 males and 136 females, aged 11-75 years （mean, 49.5 years）. The disease duration was 13-365 days （mean, 26.6 days） with a wound length of 1-25 cm （mean, 13.4 cm）. The wounds were divided into type Ⅰ （n=70）, type Ⅱ （n=64）, type Ⅲ （n--42）, type Ⅳ （n-78）, and type Ⅴ （n=6） according to self-generated classification for sternal wound complications after cardiac surgery. After debridement, wounds of type Ⅰ and type Ⅱ were repaired with local flap transplantation; wounds of type Ⅲ were repaired with local flap transplantation combined with butterfly sternal fixation （n=28）, with bilateral pectoralis muscle flap combined with butterfly sternal fixation （n=11）, and with bilateral pectoralis muscle flap （n=3）; wounds of type Ⅳ were repaired with bilateral pectoralis muscle flap （n=65）, rectus abdominis muscle flap （n=5）, and pedicled omental flap （n=8）; and wounds of type Ⅴ were repaired with pedicled omental flap. Results All the operations were successfully performed. Three patients died after pedicled omental flap repair, including 1 case of type Ⅳ and 2 cases of type Ⅴ. The hospitalization time were 4-86 days （mean, 18.3 days）. Primary wound healing was obtained in 248 cases （96.5%）; poor healing occurred in 9 patients, which were cured after second surgery in 8 cases and after the third surgery in 1 case. Conclusion The surgical treatment based on self-generated classification is appropriate to sternal wound complications after cardiac surgery. It can provide clinical evidence for the choice of subsequent operation.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2014年第9期1120-1124,共5页
Chinese Journal of Reparative and Reconstructive Surgery
基金
广东省医学科研基金资助项目(B2013019)~~
关键词
开胸手术
胸部正中难愈性伤口
分级治疗
Cardiac surgery
Sternal wound complication
Classification and management
