心脏术后胸骨骨髓炎和纵隔炎使用腹直肌带蒂肌皮瓣修复创面

目的观察心脏术后胸骨骨髓炎和纵隔炎患者使用腹直肌带蒂肌皮瓣修复胸骨缺损的疗效。方法2002年1月-2006年1月收治6例心脏术后胸骨骨髓炎和纵隔炎患者,行胸骨及部分肋骨切除,用腹直肌带蒂肌皮瓣转移修复创面。结果术后所有肌皮瓣均成活良好,无坏死,肌皮瓣成活率达100%。无胸骨骨髓炎复发,肌皮瓣有效地修复了手术清创后的胸骨及周围组织缺损,封闭了创面,修复区形态满意。术后未发生反常呼吸等情况,循环及呼吸功能正常,也未见腹部取材区域相关并发症。1例行动-静脉吻合的患者在出院前再次行血管造影检查,吻合口通畅,与周围组织有良好的血管网状吻合。所有患者术后均随访2年以上,皮瓣愈合情况均良好,无感染。结论心脏术后胸骨骨髓炎和纵隔炎使用腹直肌带蒂肌皮瓣修复胸骨缺损安全、有效。

Pedicled rectus abdominis musculocutaneous flap in reconstruction of lesions associated with sternus osteomyelitis and mediastintis secondary to heart surgery

Objective To assess the therapeutic effect of the pedicled rectus abdominis musculocutaneous (PRAM)flap for reconstruction of sternal defects associated with sternus osteomyelitis and mediastintis after sternotomy.Methods Six patients with sternus osteomyelitis and mediastinitis,who received sternotomy in Jan.2002 to Jan.2006,underwent resection of sternum and partial costal cartilage;and the surface of the wound was then repaired by PRAM flap.Results All the flaps lived well after operation with no necrosis.No reoccurrence of osteomyelitis was noticed and the PRAM flap effectively reconstructed the defects after operation,sealed the trauma,and obtained satisfactory outcome in the reconstruction sites.The circulation and respiration functions of the patients were normal after operation,with no abnormal respiration or complication in the donor sites in the abdomen.One patient who underwent arteriovenous anastomosis had patent anastomosis as revealed by angiography.The anastomosis had good communication with the adjacent tissues.All the patients obtained satisfactory healing of the flaps without infection during the over 2 years follow up.Conclusion PRAM flap is effective and safe to treat sternal defects associated with osteomyelitis and mediastinitis following cardiac operation.