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ABSTRACT Introduction: In this study, sternal complication rates of sternal closures with steel wire or steel wire combined with titanium plate in patients with obesity that underwent cardiac surgery were investigated. Methods: The data of 316 patients that underwent cardiac surgery between May 2018 and October 2021 were analyzed retrospectively; 124 patients withbody mass index (BMI) ≥ 30 kg/m2 were divided into group I, patients whose sternotomy was performed with steel wires, and group II, patients whose sternotomy was performed with steel wire combined with titanium plates. Results: A total of 124 patients with BMI ≥ 30 kg/m2 were divided into group I (n=88 [70.9%]) and group II (n=36 [29.1%]). The rate of male patients was found to be significantly higher in group I, whereas the rate of female patients was significantly higher in group II (P<0.001). BMI values were found to be low in group I and high in group II (P<0.001). The distribution of complications was different in the BMI ≥ 35.00-39.99 kg/m2 and ≥ 40 kg/m2 groups (P=0.003). Development of complications was found to be higher in patients with BMI ≥ 40 kg/m2. Sternal dehiscence was observed in two patients in group I, while no dehiscence was observed in group II. Conclusion: The lower incidence of complications and the absence of non-infectious sternal complications and sternal dehiscence in patients with BMI ≥ 35 kg/m2 that underwent steel wire combined titanium plate sternal closure strengthened the idea that plate-supported sternal closure can prevent sternal complications in high-risk patients.
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Objective@#To analysis and summarize the experience of surgical treatment of deep sternal infection caused by residual epicardial pacing.@*Methods@#Retrospective analysis of 78 patients with deep incision infection due to residual epicardial pacing lead after heart disease were selected from the Seventh Medical Center of PLA General Hospital from May 2014 to December 2018. Including 47 males and 31 females, aged 3-72 years old. 38 patients with heart valve surgery(including 18 cases with aortic valvuloplasty, 9 cases with aortic valve replacement, 11 cases with double valve replacement), 14 cases with coronary artery bypass grafting, 26 cases with congenital heart disease surgery(10 cases with atrial septal defect repairment, 11 cases with ventricular septal defect repairment, 5 cases with complex malformation surgery). All patients were infected with sternal incision due to incomplete extraction of the cardiac pacing lead, and treated with the muscle flap turnover operation. The treatment time was 1-5 years after the cardiac surgery in 32 cases, and 46 cases in 1 year.@*Results@#There was no death in the study. 70 cases were cured in stageⅠ, 5 cases in stageⅡ, and 3 cases were cured after re-operation. 71 cases were followed up for 1 year, there was no recurrence of wound infection.@*Conclusion@#The operation of pectoralis major muscle flap turnover has opened up a new approach for the treatment of thoracic incision infection caused by residual epicardial pacing lead after cardiac surgery, and it is worth popularizing in clinical practice.
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To investigate the therapeutic effect of pectoralis major muscle flap transplantation in thoracotomy patients with sternal infection. Methods From January 2014 to December 2017, the treatment group of 39 patients with thoracic bone infection after cardiac surgery was used pectoralis major muscle flap to close the wound, while 26 patients were treated by debridement and vacuum sealing drainagea at the same time as the control group. The hospitalization time, hospital costs, number of operations, satisfaction survey, and relapse rate were compared between the those. Results Compared with the control group, the treatment group has the benefit of shorter hospitalization time [(18. 1 ± 3. 8)days vs. (36. 7 ± 11. 4) days], less hospital costs [(19429 ±4088)yuan vs. (33495 ±10712)yuan], less number of operations [(1. 1 ±0. 3)times vs. (2. 4 ±0. 8)times], higher level of satisfaction(56. 4％ vs. 30. 8％), lower relapse rate(5. 1％ vs. 26. 9％), the differences are statistically significant(all P <0. 05). Conclusion Thoracic reconstruction with pectoralis major muscle flap is an effective treatment for sternal infection in postcardiac surgery.
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Background: In recent years, open heart surgery has developed rapidly in Vietnam. Sternal infection is a very serious complication for this surgery, it lead to increasing treatment costs and higher risk of mortality. Treatment of local infections is always a difficult technique in sternal wound infections after open heart operations. Objectives: (1) To improve and apply two techniques called \u201cdemi \ufffd?open + irrigation\ufffd? and \u201cclosed \ufffd?Redon drainage\ufffd? (2) To evaluate the effects of these techniques. Subjects and method: 20 cases of sternal infection (at Viet Duc hospital and some other hospitals in Ha Noi) were researched and described prospectively about diagnosis, techniques and treatment results. The subjects were divided in to 2 group based on the infection processing techniques. Results:Diagnosis had to reply on clinical signals (100%). Bacterial culture only provided 45% positive results, Pseudomonas aeruginosa (44.4%) were obtained more than Staphylococcus au\u2019reus (22.2%). Both techniques have their own reasonable creativeness and the standardized process, improving the limitations of ordinary technique, providing high treatment effectiveness \ufffd?85% have recovered after only one operation. Conclusion: For treatment of local infections, two techniques are both very efficient and suitable with the conditions in Vietnam, especially \u201cclosed \ufffd?Redon drainage\ufffd?technique.