Sternum Enfeksiyonlarının Tedavisinde Negatif Basınç Yardımlı Yara Bakım Sistemi ve Pektoralis Majör Flebi Kombinasyonu: Olgu Sunumu

Year 2014, Volume: 22 Issue: 3, 117 - 120, 01.12.2014

Mehtap Karameşe Osman Akdağ Gökçe Ünal Yıldıran Muhammed Nebil Selimoğlu Niyazi Görmüş Zekeriya Tosun

Abstract

Açık kardiyak cerrahi sonrası gelişen yara yeri enfeksiyonları, sternal osteomiyelit ve mediastinit gibi hayati tehdit eden durumlar olarak cerrahların karşısına çıkmaktadır. Tedavisinde multidisipliner yaklaşımla, antibiyoterapi, cerrahi debridmanlar sonrasında flep seçenekleri ile rekonstrüksiyon uygulanmaktadır. Günümüzde bilinen tedavi protokollerinin yanı sıra yara bakımı için geliştirilmiş yöntemler tanımlanmıştır. Çoğu hasta; osteomiyelite yönelik kemik debridmanını takiben sternum instabilitesi, ventrikül rüptürü, pnömoni gibi sebeplerle kaybedilmektedir. Bu yazıda, internal mamariyan arterin greft olarak kullanıldığı, diyabetik, koroner bypass hastasında gelişen, postoperatif mediastinit tedavisinde negatif basınçlı pansuman ve pektoral kas flebi ile rekonstrüksiyon uygulaması sunulmuştur. Mortalitesi oldukça yüksek mediastinit vakalarında, enfeksiyonu kontrol altına alan, yara bakımı sağlayan negatif basınçlı pansumandan faydalanmak, etkili bir tedavi alternatifi olarak sunulmaktadır.

Keywords

Sternal osteomiyelit, Mediastinit, VAC

Vacuum Therapy and Pectoralis Major Muscle Flap Combination in Treatment of Sternal Infections: A Case Report

Abstract

Wound infections subsequent to cardiac surgery are challenging surgeons because of being life-threatening situations and these infections are among conditions that require multidisciplinary approach. Antibiotherapy, surgical debridements, regional or free flap surgeries are used by multidisciplinary approach in the treatment of sternal wound infections. Beside these known alternatives, some other methods are advanced for wound care. However; sternal instability, ventricular rupture and pneumonia may be mortal in many patient as the course of the disease. In this article, a negative pressure wound therapy and reconstruction with pectoralis major muscle flap was introduced for postoperative mediastinitis occurred in a diabetic, coronary bypass patient. A wound therapy, that controls infection and supplies wound care as an effective treatment alternative for highly mortal mediastinis cases.

Keywords

Sternal osteomiyelit, Mediastinit, VAC

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