Immediate Debridement and Reconstruction with a Pectoralis Major Muscle Flap for Poststernotomy Mediastinitis

Jang, Yu-Jin; Park, Myong-Chul; Park, Dong-Ha; Lim, Hyo-Seob; Kim, Joo-Hyoung; Lee, Il-Jae

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자료유형: 학술저널

저자정보: Jang, Yu-Jin (Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine) Park, Myong-Chul (Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine) Park, Dong-Ha (Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine) Lim, Hyo-Seob (Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine) Kim, Joo-Hyoung (Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine) Lee, Il-Jae (Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine)

저널정보: 대한성형외과학회 Archives of plastic surgery : APS Archives of plastic surgery : APS 제39권 제1호

발행연도: 2012.1

수록면: 36 - 41 (6page)

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Background : Poststernotomy mediastinitis is a rare, but life-threatening complication, thus early diagnosis and proper management is essential for poststernotomy mediastinitis. The main treatment for mediastinitis is aggressive debridement. Several options exist for reconstruction of defects after debridement. The efficacy of immediate debridement and reconstruction with a pectoralis major muscle flap designed for the defect immediately after the diagnosis of poststernotomy mediastinitis is demonstrated. Methods : Between September 2009 and June 2011, 6 patients were referred to the Department of Plastic and Reconstructive Surgery and the Department of Thoracic and Cardiovascular Surgery of Ajou University Hospital for poststernotomy mediastinitis. All of the patients underwent extensive debridement and reconstruction with pectoralis major muscle flaps, advanced based on the pedicle of the thoracoacromial artery as soon as possible following diagnosis. A retrospective review of the 6 cases was performed to evaluate infection control, postoperative morbidity, and mortality. Results : All patients had complete wound closures and reduced severity of infections based on the erythrocyte sedimentation rate and C-reactive protein levels and a reduction in poststernal fluid collection on computed tomography an average of 6 days postoperatively. A lack of growth of organisms in the wound culture was demonstrated after 3 weeks. There were no major wound morbidities, such as hematomas, but one minor complication required a skin graft caused by skin flap necrosis. No patient expired after definitive surgery. Conclusions : Immediate debridement and reconstruction using a pectoralis major muscle flap is a safe technique for managing infections associated with poststernotomy mediastinitis, and is associated with minimal morbidity and mortality.

#Mediastinitis #Pectoralis muscle #Pedicled flap

참고문헌 (14)

참고문헌 신청

Domkowski PW / 2003 / Evaluation of vacuum-assisted closure in the treatment of poststernotomy mediastinitis / J Thorac Cardiovasc Surg 126:386~390

Mangram AJ / 1999 / Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee / Infect Control Hosp Epidemiol 20:250~278

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Lopez-Monjardin H / 1998 / Omentum flap versus pectoralis major flap in the treatment of mediastinitis / Plast Reconstr Surg 101:1481~1485

Jurkiewicz MJ / 1980 / Infected median sternotomy wound: successful treatment by muscle flaps / Ann Surg 191:738~744