유영천·정승일·앙원용·박
준
경희대학교
의과대학 성형외과학 교실
Treatment
of Acute Sterno-Mediastinitis using Regional Muscle
Flaps
Young Cheun Yoo M.D.. Seung il Chung, M.D..
Won Yong Yang, M.D.. Jun Park, M.D.
Department
of Plastic and Reconstructure Surgery,
College
of Medicine, KyungHee University, Seoul, Korea
Although
the incidence of mediastinal wound infection after
median sternotomy is re1ative1y low, its associated
devastating complications may be life-threatening.
Treatment of sterno-mediastina1 infection has evolved
over the past several decades. Early treatment was
wet soaking of debrided wound or irrigation through
a closed indwelling catheter system and its mortality
was quite high. Subsequent treatments focused on
the debridement followed by muscle flaps such as
pectora1is major and rectus abdominis muscle flap
or by omental flap closure, which were considered
as the ideal modalities for acute stemo-mediastinitis.
Mortality rate was reduced significant1y after application
of this active treatment. However. to date, there
has been no definite treatment strategy for sterno-mediastinitis
and choice of operations depends largely on the
experience and personal preference of the surgeon.
So we introduce our experience, including technique
and outcome, with transposition of pectoralis major
muscle and superiorly-based rectus abdominis muscle
turn over flap for deep and extensive sterno-mediastinal
wounds. Five patients(3 male and 2 female) had repair
of an infected median sternotomy wound from July
2001 to september 2002. Complications after wound
closure occured in 2 cases, 1 case of hematoma and
1 case of seroma, respectively. No other major complications
have been noted. We treated MRSA or VRE-cultured
acute sterno-mediastinitis successfully with early
sternal wound debridement and immediate regional
muscle flap coverage
Key
Words : Acute sterno-mediastinitis, Muscle flap |
