Abstract：
BACKGROUND: Sternotomy wound complications are more frequent after orthotopic heart transplantation (OHT) compared to other cardiac surgeries, primarily due to additional risk factors, including immunosuppression. Flap closure often becomes necessary for definitive treatment, although there is a scarcity of data on the outcomes of sternal wound reconstruction in this specific population.
METHODS: A retrospective analysis was conducted on 604 sternal wound reconstructions performed by a single surgeon between 1996 and 2023. Inclusion criteria comprised patients who underwent OHT as their primary cardiac procedure. Surgical interventions involved sternal hardware removal, debridement, and muscle flap closure.
RESULTS: The study included 66 patients, with culture-positive wound infection being the most common indication for reconstruction (51.5%). The median duration between transplantation and sternal wound reconstruction was 25 days. Bilateral pectoralis major myocutaneous advancement flaps (n = 63), rectus abdominis flaps (n = 2), or pectoralis major turnover flaps (n = 1) were used. Intraoperative wound cultures revealed positivity in 48 patients (72.7%), with Staphylococcus epidermidis being the most frequently cultured organism (25.0%). The overall complication rate was 31.8%, and two patient deaths were related to sternal wounds, resulting from multiorgan failure following septic shock. The majority of the patients reported excellent long-term functional and esthetic outcomes.
CONCLUSIONS: Sternal wounds following OHT pose a significant morbidity risk. Our strategy focuses on immediate and aggressive antibiotic therapy, thorough debridement, and definitive closure with bilateral pectoralis myocutaneous advancement flaps. This approach has demonstrated complication and mortality rates comparable to the general cardiac surgery population, as well as excellent functional and esthetic results.
METHODS: A retrospective analysis was conducted on 604 sternal wound reconstructions performed by a single surgeon between 1996 and 2023. Inclusion criteria comprised patients who underwent OHT as their primary cardiac procedure. Surgical interventions involved sternal hardware removal, debridement, and muscle flap closure.
RESULTS: The study included 66 patients, with culture-positive wound infection being the most common indication for reconstruction (51.5%). The median duration between transplantation and sternal wound reconstruction was 25 days. Bilateral pectoralis major myocutaneous advancement flaps (n = 63), rectus abdominis flaps (n = 2), or pectoralis major turnover flaps (n = 1) were used. Intraoperative wound cultures revealed positivity in 48 patients (72.7%), with Staphylococcus epidermidis being the most frequently cultured organism (25.0%). The overall complication rate was 31.8%, and two patient deaths were related to sternal wounds, resulting from multiorgan failure following septic shock. The majority of the patients reported excellent long-term functional and esthetic outcomes.
CONCLUSIONS: Sternal wounds following OHT pose a significant morbidity risk. Our strategy focuses on immediate and aggressive antibiotic therapy, thorough debridement, and definitive closure with bilateral pectoralis myocutaneous advancement flaps. This approach has demonstrated complication and mortality rates comparable to the general cardiac surgery population, as well as excellent functional and esthetic results.
摘要：
背景：与其他心脏手术相比，原位心脏移植（OHT）后胸骨切开术伤口并发症更常见，主要是由于额外的风险因素，包括免疫抑制。对于确定的治疗，皮瓣闭合通常变得必要，尽管缺乏关于这一特定人群胸骨伤口重建结果的数据。
方法：对1996年至2023年由一名外科医生进行的604例胸骨伤口重建进行了回顾性分析。纳入标准包括接受OHT作为主要心脏手术的患者。手术干预涉及胸骨硬件切除，清创术,和肌肉皮瓣闭合。
结果：该研究包括66名患者，培养阳性伤口感染是最常见的重建指征(51.5%)。移植和胸骨伤口重建之间的中位持续时间为25天。双侧胸大肌肌肌皮瓣（n=63），腹直肌皮瓣（n=2），或使用胸大肌翻转皮瓣（n=1）。术中伤口培养显示48例患者（72.7%）阳性，表皮葡萄球菌是最常见的培养生物（25.0％）。总并发症发生率为31.8%,两名患者的死亡与胸骨伤口有关，由感染性休克后的多器官衰竭引起。大多数患者报告了良好的长期功能和美学结果。
结论：OHT后的胸骨创伤具有显著的发病风险。我们的战略重点是立即和积极的抗生素治疗，彻底清创,和双侧胸肌肌皮瓣的最终闭合。这种方法已证明并发症和死亡率与普通心脏手术人群相当，以及出色的功能和美学效果。
方法：对1996年至2023年由一名外科医生进行的604例胸骨伤口重建进行了回顾性分析。纳入标准包括接受OHT作为主要心脏手术的患者。手术干预涉及胸骨硬件切除，清创术,和肌肉皮瓣闭合。
结果：该研究包括66名患者，培养阳性伤口感染是最常见的重建指征(51.5%)。移植和胸骨伤口重建之间的中位持续时间为25天。双侧胸大肌肌肌皮瓣（n=63），腹直肌皮瓣（n=2），或使用胸大肌翻转皮瓣（n=1）。术中伤口培养显示48例患者（72.7%）阳性，表皮葡萄球菌是最常见的培养生物（25.0％）。总并发症发生率为31.8%,两名患者的死亡与胸骨伤口有关，由感染性休克后的多器官衰竭引起。大多数患者报告了良好的长期功能和美学结果。
结论：OHT后的胸骨创伤具有显著的发病风险。我们的战略重点是立即和积极的抗生素治疗，彻底清创,和双侧胸肌肌皮瓣的最终闭合。这种方法已证明并发症和死亡率与普通心脏手术人群相当，以及出色的功能和美学效果。
