心脏术后常见胸部正中切口愈合不良的治疗策略

目的　探讨心脏术后不同类型胸部正中切口愈合不良的治疗策略。方法　回顾性分析2017年2月至2020年1月阜外华中心血管病医院1 067例成人患者，手术涵盖冠状动脉搭桥、心脏瓣膜成形或置换、冠状动脉搭桥+瓣膜成形或置换、先天性心脏病矫治、改良扩大Morrow术等，均采用胸部正中手术切口，术后44例患者出现不同类型的切口愈合不良，其中男19例、女25例，年龄（65.2±6.73）岁。经积极处理，均愈合良好。结果　14例患者胸部正中切口脂肪液化，予以换药加压包扎，痊愈；11例患者胸部正中局部切口愈合不良，清创后予以二次缝合术，痊愈；10例患者胸部正中切口全程愈合不良，清创后予以二次缝合术，除1例愈合欠佳，中段再次予以清创缝合术，均愈合良好；5例术后胸骨钢丝松动，收紧钢丝后予以清创缝合术，愈合良好；4例胸骨哆开，予以胸大肌皮瓣翻转术，一次性治愈。结论　针对心脏术后不同类型的胸部正中手术切口愈合不良，采取个体化的治疗方法，均可以取得满意的临床效果。

Treatment strategy for common poor healing of median thoracic incision after cardiac surgery

Objective　To explore the treatment strategies for different types of poor healing of median thoracic incision after cardiac surgery. Methods　A retrospective analysis was performed on 1 067 adult patients in Fuwai Huazhong Cardiovascular Hospital from February 2017 to January 2020. The operations included coronary artery bypass grafting, heart valve repair or replacement, coronary artery bypass grafting + valve repair or replacement, correction of congenital heart disease, modified extended Morrow procedure, etc. All of them adopted the median thoracic surgical incision. After operation, 44 patients had different types of poor incision healing, including 19 males and 25 females, aged (65.2±6.73) years. After active treatment, all of them healed well. Results　The fat liquefaction of median thoracic incision occurred in 14 cases, and all of them were cured by dressing change and pressure bandage. The poor healing of local median thoracic incision occurred in 11 cases, and all of them were cured by secondary suturing after debridement. The whole median thoracic incision was poorly healed in 10 cases, the secondary suturing was performed after debridement; the middle incision in 1 case was given debridement and suturing again, and the other cases all healed well. The sternal wire loosening occurred in 5 cases, the debridement and suturing were performed after tightening the wire, and the healing was good. The sternum dehiscence occurred in 4 cases, all of them were treated with transposition of pectoralis major myocutaneous flap and were cured at one time. Conclusion　For different types of poor incision healing of median thoracic operation after cardiac surgery, taking individualized treatment methods can achieve satisfactory clinical results.