Résumé
Sternal osteomyelitis after median sternotomy for cardiac surgery is associated with considerable morbidity and mortality. The ideal reconstruction after sternal debridement is still debated. Between January 2004 and July 2008, we treated 12 patients for sternal osteomyelitis with wound dehiscence after median sternotomy for cardiac surgery. Extensive debridement of the sternum were performed in all cases. The defect was covered by omental transposition followed by split-thickness skin graft 7-10 days later. Two-stage procedure was employed in all patients. Hospital stay ranged from 21 to 45 days. Five patients had previous muscle flaps. Partial necrosis of the omental flap occurred in one case. There was total resolution of the sternal infection in all patients. No recurrence of dehiscence was observed during 6 to 24 months of follow-up. Extensive dbridement along with omental flap transposition provides definitive control of the infection in cases of failure of other conservative or surgical interventions of median sternotomy wound dehiscence
Sujets)
Humains , Mâle , Femelle , Ostéomyélite/chirurgie , Sternum , OmentumRésumé
Pilonidal sinus disease of the natal cleft is a painful debilitating condition which often recurs despite different surgical procedures. In this thesis, the outcome of different methods for treatment of this disease are described and compared. A review of sixty patients were randomized into three groups. Group A were operated upon by sinus excision and leaving the resultant cavity to heal by granulation tissue. Group B were operated by excision with primary closure in natal cleft. Group C were operated by excision with oblique closure by z-plasty. Recurrence was highest in group B [25%] followed by group A [15%] and no recurrence occurred in group C. The mean satisfaction grading was 5, 2 in group A, 7.1 in group B and 9.3 in group c. Excision of pilonidal sinus and oblique closure by z-plasty offers improved patient satisfaction and no recurrence rate