Sternum Enfeksiyonlarının Tedavisinde Negatif Basınç Yardımlı Yara Bakım Sistemi ve Pektoralis Majör Flebi Kombinasyonu: Olgu Sunumu
Öz
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.
Anahtar Kelimeler
Kaynakça
- Sjögren J, Malmsjö M. Gustafsson R, Ingemansson R. Postster- 1.
- notomy mediastinitis: a rewiew of conventional surgical treat
- ments, vacuum-assisted closure therapy and presentation of
- the Lund University Hospital mediastinitis algorithm. Eur J of
- Cardiothorac Surg. 2005;30: 898-905.
- Scholl L, Chang E, Reitz B. Chang J. Sternal osteomyelitis: use of 2.
- vacuum-asissted closure device as an adjunct to definitive clo
- sure with sternectomy and muscle flap reconstruction. J Card
- Surg. 2004;19:453-61.
- Hersh RE, Jack JM, Dahman MI, Morgan RF, Drake DB. The vacu- 3.
- um-asissted closure device as a bridge to sternal wound closure.
- Ann Plast Surg. 2001;46:250-4. wound complications with pectoralis major myocutaneous ad- vancement flaps. Plast Reconstr Surg. 1994;93:1433-41.
- Morykwas MJ, Argenta LC, Shelton-Brown El, McGuirt W. 9.
- Vacuum-asissted closure: a new method for control and treat
- ment: animal studies and basic foundation. Ann Plast Surg.
- ;38:553-62. 10. Petzina R, Gustafsson L, Mokhtari A, Ingemansson R, Malmsjö M.
- Effect of vacuum-asissted closure on blood flow in the perister
- nal thoracic wall after internal mammary artery harvesting. Eur J
- Cardiothorac Surg. 2006;30:85-9. 11. Conquest AM, Garofalo JH, Maziarz DM Mendelson KG, Su Sun Y,
- Wooden WA et al. Hemodynamic effects of the vacuum-asissted
- closure device on open mediastinal wounds. J Surg Research. 2003;115:209-13.
- Hugo NE, Sultan MR, Ascherman JA, Patsis MC, Smith CR, Rose 8.
- EA. Single-stage management of 74 consecutive sternal sternal
Vacuum Therapy and Pectoralis Major Muscle Flap Combination in Treatment of Sternal Infections: A Case Report
Öz
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.
Anahtar Kelimeler
Kaynakça
- Sjögren J, Malmsjö M. Gustafsson R, Ingemansson R. Postster- 1.
- notomy mediastinitis: a rewiew of conventional surgical treat
- ments, vacuum-assisted closure therapy and presentation of
- the Lund University Hospital mediastinitis algorithm. Eur J of
- Cardiothorac Surg. 2005;30: 898-905.
- Scholl L, Chang E, Reitz B. Chang J. Sternal osteomyelitis: use of 2.
- vacuum-asissted closure device as an adjunct to definitive clo
- sure with sternectomy and muscle flap reconstruction. J Card
- Surg. 2004;19:453-61.
- Hersh RE, Jack JM, Dahman MI, Morgan RF, Drake DB. The vacu- 3.
- um-asissted closure device as a bridge to sternal wound closure.
- Ann Plast Surg. 2001;46:250-4. wound complications with pectoralis major myocutaneous ad- vancement flaps. Plast Reconstr Surg. 1994;93:1433-41.
- Morykwas MJ, Argenta LC, Shelton-Brown El, McGuirt W. 9.
- Vacuum-asissted closure: a new method for control and treat
- ment: animal studies and basic foundation. Ann Plast Surg.
- ;38:553-62. 10. Petzina R, Gustafsson L, Mokhtari A, Ingemansson R, Malmsjö M.
- Effect of vacuum-asissted closure on blood flow in the perister
- nal thoracic wall after internal mammary artery harvesting. Eur J
- Cardiothorac Surg. 2006;30:85-9. 11. Conquest AM, Garofalo JH, Maziarz DM Mendelson KG, Su Sun Y,
- Wooden WA et al. Hemodynamic effects of the vacuum-asissted
- closure device on open mediastinal wounds. J Surg Research. 2003;115:209-13.
- Hugo NE, Sultan MR, Ascherman JA, Patsis MC, Smith CR, Rose 8.
- EA. Single-stage management of 74 consecutive sternal sternal
Ayrıntılar
| Diğer ID | JA59CT89BA |
|---|---|
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Aralık 2014 |
| Yayımlandığı Sayı | Yıl 2014 Cilt: 22 Sayı: 3 |