带蒂肌瓣转移联合负压吸引一期重建治疗心脏术后复杂性纵隔感染

目的总结心脏术后复杂性纵隔感染的外科治疗经验，探讨最佳治疗策略。方法回顾性分析首都医科大学附属北京安贞医院心外科2006年6月至2012年12月期间，应用带蒂肌瓣转移填充及负压吸引一期重建治疗心脏直视术后复杂性纵隔感染18例的临床资料。其中男12例、女6例，平均年龄（65．5±8．2）岁。心脏手术与肌瓣重建时间间隔（12．5±5．8）d。彻底清创，拔除全部钢丝，游离双侧胸大肌瓣向中线牵拉，填充胸骨间隙并覆盖胸骨，无张力缝合肌瓣，纵隔及皮下置引流管负压吸引，关闭创口。胸骨缺损较大者，需游离一侧腹直肌瓣上提填充缺损，再按上述方法一期重建。结果1例患者术后早期死于纵隔感染复发，脓毒血症及多器官功能衰竭。17例患者术后过程顺利，创口一期愈合。重建术后住院时间（18．6±7.2）d，创口愈合时间（4．5±2．4）周。17例患者随访6个月以上未见纵隔感染复发，工作生活质量良好。结论带蒂肌瓣转移联合负压吸引一期重建治疗心脏术后复杂性纵隔感染效果确切，手术简单，易于推广。

Vascularized Muscle Flap Transposition Combined with Negative Pressure Wound Therapy for the Treatment of Complicated Mediastinitis after Cardiac Surgery in One-stage

Objective To summarize surgical experience and explore the best treatment strategy for the management of complicated mediastinitis after cardiac surgery. Methods Clinical data of 18 patients who received vascularized muscle flap transposition combined with negative pressure wound therapy （NPWT） for the treatment of complicated mediastinitis after cardiac surgery in one stage in the Department of Cardiac Surgery of Beijing Anzhen Hospital, Capital Medical University between June 2006 and December 2012 were retrospective analyzed. There were 12 male and 6 female patients with their average age of 65.5 ±8.2 years. The average interval between cardiac surgery and vascularized muscle flap reconstruction was 12.5±5.8 days. Results Postoperatively, 1 patient died of recurrent mediastinitis, sepsis and multiple organ dysfunction syndrome. Seventeen patients had an uneventful postoperative recovery and one-stage wound healing. Postoperative hospital stay was 18.6 ±7.2 days and wound healing time was 4.5 ± 2.4 weeks. All the 17 patients were followed up for over 6 months, no recurrent mediastinitis was observed, and they had a good quality of life. Conclusion Vascularized muscle flap trans-position combined with NPWT is a simple and effective surgical strategy for the treatment of complicated mediastinitis after cardiac surgery in one-stage.