A Reliable Procedure for Reconstruction of the Sternum Defects: The Pectoralis Major Muscle Flap Combination with Negative Pressure Wound Therapy

Abstract

Objective: Sternotomy defects may present mildly as isolated skin separation or severely as mediastinitis. A combination of treatment options can support treatment. Methods: Patients who were treated with pectoralis major flap with the combination of negative pressure wound therapy (NPWT) between 2016-2020, were retrospectively reviewed. Demographic features, microorganisms causing wound infection, flap reconstruction preference, time of hospitalization, remission, recurrence and associated morbidity and mortality data were evaluated. Results: Thirteen patients were included with a mean age of 65.4 years. All patients previously underwent coronary artery bypass graft surgery. Wound cultures from patients were positive in nine (69%). Isolated microorganisms were Staphylococcus spp. (n=4), Klebsiella pneumoniae (n=3) and Acinetobacter baumannii complex (n=2). The most common comorbidities were hypertension (76%) and diabetes mellitus(46%). The average hospital stay was 23.4 days. One patient died on the seventh postoperative day, two had seromas at the flap donor site, and one had hematoma. Conclusion: Pectoralis major muscle flap and NPWT after complete removal of dead tissues is an effective method to repair and treat sternum defects.

Keywords

• mediastinitis
• negative pressure wound therapy
• pectoral muscle flap
• sternal reconstruction

Sternum Defektlerinin Rekonstrüksiyonunda Güvenilir Bir Yöntem: Pektoralis Major Kas Flebi ile Negatif Basınçlı Yara Bakım Kombinasyonu

Abstract

Giriş: Sternotomi defektleri izole cilt ayrılması gibi hafif ya da mediastinit gibi ağır tablolarla karşımıza çıkabilir. Tedavi seçeneklerinin kombinasyonu tedaviyi destekleyebilir. Yöntem: 2016-2020 yılları arasında pektoralis majör flebi ve negative basınçlı yara bakımı (VAC) kombinasyonuyla tedavi edilen hastalar retrospektif olarak incelendi. Demografik özellikler, yara kültüründe üreyen mikroorganizmalar, flep rekonstrüksiyonu tercihi, ameliyat sonrası hastanede kalış süresi, tam iyileşme, nüks ve ilişkili morbidite ve mortalite verileri değerlendirildi. Bulgular: Toplam 13 hasta çalışmaya dahil edildi. Ortalama yaş 65.4 idi. Tüm hastaların koroner arter greftlenmesi ameliyatı hikayesi vardı. Hastaların 9 tanesinde yara kültürlerinde üreme vardı. Dört hastada Staphylococcus türleri, üçünde Klebsiella pneumoniae ve ikisinde Acinetobacter baumannii üredi. En sık eşlik eden hastalıklar %76 hipertansiyon ve %46 diabetes mellitus idi. Ortalama hastanede kalış süresi 23,4 gündü. Bir hasta ameliyat sonrası 7.günde öldü, ikisinde flep donör sahasında seroma, birinde hematom görüldü. Sonuç: Ölü dokuların tamamen temizlenmesi sonrası pectoral defektin kombine pektoral kas flebi ve negative basınçlı yara bakımı ile onarılarak tedavi edilmesi etkili bir yöntemdir.

Keywords

• mediastinit
• negatif basınçlı yara tedavisi
• pektoral kas flebi
• sternal rekonstrüksiyon

Thanks

Kocaeli Üniversitesi KVC yoğun bakım servisi çalışanlarına teşekkür ederiz.

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