简介:大心脏手术后的深部胸骨伤口感染是一种有害的并发症,有后遗症,可能危及生命。在心胸和重建文献中,已经记录了使用真空辅助闭合疗法治疗胸骨伤口并导致右心室破裂的情况。方法/病例报告:我们介绍了一例67岁的男性患者,该患者在清创深部胸骨伤口感染并放置真空辅助闭合装置后,因浮动肋骨而导致右心室穿孔。结果:尽管精心清创并确保所有胸骨后粘连的释放,应用真空辅助封堵装置后不久出现大量出血.幸运的是,并发症的快速识别和直接手动压力的应用允许迅速返回手术室修复缺陷。患者随后用网膜皮瓣和双侧胸肌前移皮瓣彻底闭合了纵隔伤口。讨论:根据本文的结论,重建外科医生应该能够(1)识别有心室穿孔风险的患者,(2)在使用真空辅助闭合治疗时,术中用尽所有手段以防止心脏穿孔,(3)了解与该患者人群中使用真空辅助闭合相关的生理学,(4)术后有真空辅助封闭治疗胸骨深部伤口感染患者的治疗方案,(5)了解心室破裂治疗的基本原则,以确保及时修复和生存。
Introduction: Deep sternal wound infection following major cardiac surgery is a deleterious complication with sequelae that can be life threatening. The use of vacuum-assisted closure therapy in management of sternal wounds with resultant right ventricular rupture has been documented in the cardiothoracic and to a lesser extent in the reconstructive literature. Methods/
Case Report: We present a
case of a 67-year-old male patient who suffered from right ventricular perforation from a floating rib following debridement of a deep sternal wound infection and placement of a vacuum-assisted closure device. Results: Despite meticulous debridement and ensuring the release of all retrosternal adhesions, massive bleeding was encountered shortly after application of the vacuum-assisted closure device. Fortunately, quick identification of the complication and the application of direct manual pressure allowed for swift return to the operating room for repair of the defect. The patient secondarily underwent definitive closure of the mediastinal wound with an omental flap and bilateral pectoral advancement flaps. Discussion: Following the conclusion of this article, the reconstructive surgeon should be able to (1) identify patients at risk for ventricular perforation, (2) exhaust all means intraoperatively to prevent cardiac perforation when using vacuum-assisted closure therapy, (3) comprehend the physiology associated with vacuum-assisted closure use in this patient population, (4) have protocols in place for the management of patients with deep sternal wound infection with vacuum-assisted closure therapy postoperatively, and (5) understand basic tenets of ventricular rupture treatment should this occur to ensure prompt repair and survival.