Mustafa DURGUN, Emre İNÖZÜ, Ali Teoman TELLİOĞLU, Suna DURGUN ÖGÜCÜ, Hülda ÖZAKPINAR RIFAT, Avni Tolga ERYILMAZ, Hüseyin Fatih ÖKTEM

Mediastinit tedavisinde enfekte sternotomi yaralarına yaklaşım

Amaç: Bu çalışmada, koroner arter baypas greft (KABG) cerrahisi sonrasında ortaya çıkan sternum yaralarının tedavisinde uygulanan cerrahi seçenekler tartışıldı ve en uygun yöntem belirlenmeye çalışıldı. Çalışma planı: Bu çalışmada, Mart 2005 - Mart 2011 tarihleri arasında KABG cerrahisi sonrası sternal bölgede oluşan doku defekti nedeni ile kliniğimize sevk edilen 27 hasta (11 kadın, 16 erkek; ort. yaş 63 yıl; dağılım 53-77 yıl) değerlendirildi. Bulgular: On hastada yüzeyel olan defektler deri grefti ile onarıldı. Sternum kemiğinin açıkta olduğu 17 hastada, toplam 11 pektoral kas-deri flebi ve sekiz rektus abdominis kas flebi uygulandı. Sonuç: Koroner arter baypas cerrahisi sonrasında oluşan yüzeyel defektler deri grefti ile kolaylıkla onarılabilir. Derin olan sternum üst 2/3ündeki defektlerin kapatılmasında pektoral kas-deri flebi, alt 1/3ündeki defektlerin onarımında rektus abdominis kas flebinin kullanımı daha uygundur.

Approach to of infected sternotomy wounds in the management of mediastinitis

Background: In this study, we aimed to discuss the surgical options for the management of sternum wounds due to coronary artery bypass graft (CABG) surgery and to establish the most appropriate method. Methods: In this study, we evaluated 27 patients (11 females, 16 males; mean age 63 years; range 53 to 77 years) who were referred to our clinic with tissue defect of sternum after CABG surgery between March 2005 and March 2011. Results: Ten patients with superficial defects were reconstructed with skin grafting. Remaining 17 patients with exposed sternal bone underwent repair with 11 pectoral muscle-skin flaps and eight rectus abdominis muscle flaps. Conclusion: The superficial defects which occur after CABG surgery can be easily treated by skin grafting. The most suitable method for the reconstruction of the deep sternal defects are pectoralis muscle flap for the upper 2/3 defects and rectus abdominis muscle flap for the lower 1/3 defects.

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