Chih-Hung Lin, Cheng-Hung Lin, Feng-Chun Tsai, Pyng-Jing Lin
Journal of Reconstructive Microsurgery 2019; 35(09): 705-712
摘要：
一、背景：雙側胸大肌或腹直肌與網膜的組合通常用於上胸部和下胸骨傷口感染。 使用內視鏡輔助方法可以簡單，安全且可靠的進行整個單側胸大肌皮瓣採集，且能具有較少的供體部位侵犯的結果。
二、方法：對2003年至2015年進行了一項回顧性研究，將此時間段共38名患者進行了一次單一整形外科的手術治療，此治療用於心內直視胸骨切開術後胸骨傷口的感染。 在內視鏡可視化的幫助下切除與肱骨相連的胸大肌後，將胸骨、肋骨、和鎖骨上的所有其他胸大肌分開，單側帶蒂的胸大肌可以前進約10cm以覆蓋頭部和尾部胸骨，並且 填補胸骨後縱隔。
三、結果：對3例術後血腫患者進行了4次再次探查。患者中沒有發生傷口裂開的早期復發感染。 三名患者死於多器官功能衰竭，死亡週期為30天。 兩名患者罹患晚期復發感染；其中一名患者在復發感染轉移後4個月和6個月時各有進行一次感染清創手術，另一名患者在3年內另患有一次肋骨骨髓炎。
結論：單側胸大肌轉移是合理的，可為胸骨感染管理和縱隔閉塞提供簡單，可靠，直接的手術，而不會在受損患者中侵犯第二瓣。
Abstract
Background Bilateral PM muscles or combination with rectus abdominis or omentum are commonly used for upper and lower sternal wound infections. Unilateral PM harvesting using endoscopic-assisted method may have a simple, safe, and reliable entire muscle harvesting with comparable result of less donor-site violation.
Methods A retrospective review was performed from 2003 till 2015 on 38 patients referred to a single plastic surgeon for treatment of sternal wound infection following median sternotomy for cardiovascular surgery. After the humerus insertion of PM was cut with the assistance of endoscope visualization, all the other PM insertions on the sternum, rib, and clavicle were divided, the unilateral pedicled PM can be advanced approximately 10 cm to cover the cephalad and caudal sternum, and fill the retrosternal mediastinum.
Results Four re-explorations in three patients for postoperative hematoma occurred. No early recurrent infection for wound dehiscence experienced. Three patients died of multiple organs failures as 30-day mortality. Two patients underwent late recurrent infections; one patient had twice wire infection removals at 4 and 6 months after transfer, and the other had another PM for rib osteomyelitis in 3 years.
Conclusion Unilateral PM transfer is justified to provide a simple, reliable, straightforward procedure for sternal infection management and mediastinal obliteration without violation of second flap in compromised patients.
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