Surgical treatment of 655 patients with deep chest wall infection: A single-center retrospective analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 WANG Wenzhang , FENG Qing , YANG Shiyan , LIANG Zhuoru , CHENG Xiangyi , WANG Jing , LI Bowen , WANG Xiaofang , WANG Xiaohong

Department of Cardiothoracic Surgery, Yanda Hospital of Hebei Medical University, Langfang, 065201, Hebei, P. R. China;

Corresponding author：

WANG Wenzhang, Email: wwz9993@163.com

Keywords：

Deep chest wall infection; radiotherapy; tumor necrosis; incision infection

DOI：

10.7507/1007-4848.202012083

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Objective To explore the surgical treatment of deep chest wall infection, improve the cure rate and reduce the recurrence rate.Methods The clinical data of 655 patients with deep chest wall infection treated in Yanda Hospital and Beijing Royal Integrative Medicine Hospital from June 2015 to June 2020 were retrospectively analyzed. There were 450 males and 205 females, aged 55.6±12.8 years. There were 8 patients with chest wall infection after tumor necrosis, 15 patients after radiotherapy and 632 patients after thoracotomy (612 patients after cardiovascular surgery and 20 patients after general thoracic surgery). Among them, 649 patients underwent debridement and reconstruction of chest wall defect with muscle flap.Results The average operation time was 95±65 min, the average intraoperative blood loss was 180±100 mL, and the average postoperative hospital stay was 13±6 d. Of the 649 patients who underwent muscle flap reconstruction after debridement, 597 patients recovered within 2 weeks, and the primary wound healing rate was 94.4%. Twenty-three (3.5%) patients died. The median follow-up time was 25 (2-40) months. Among the remaining 632 patients, 20 recurred, with a recurrence rate of 3.1% (20/632).Conclusion Pedicled muscle flap after thorough debridement of deep chest wall infection is one of the best methods to repair chest wall defect with pedicled muscle flap.

Citation： WANG Wenzhang, FENG Qing, YANG Shiyan, LIANG Zhuoru, CHENG Xiangyi, WANG Jing, LI Bowen, WANG Xiaofang, WANG Xiaohong. Surgical treatment of 655 patients with deep chest wall infection: A single-center retrospective analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(7): 904-908. doi: 10.7507/1007-4848.202012083 Copy

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7.	Deniz H, Gokaslan G, Arslanoglu Y, et al. Treatment outcomes of postoperative mediastinitis in cardiac surgery; negative pressure wound therapy versus conventional treatment. J Cardiothorac Surg, 2012, 7: 67.
8.	王显悦, 王晓武, 毕生辉, 等. 封闭负压引流技术在心脏手术后切口感染治疗中的应用. 中国胸心血管外科临床杂志, 2012, 19(5): 529-533.
9.	Schols RM, Lauwers TM, Geskes GG, et al. Deep sternal wound infection after open heart surgery: Current treatment insights. A retrospective study of 36 cases. Eur J Plast Surg, 2011, 34(6): 487-492.
10.	Wang W, Cai A. Analysis of surgical treatment with pectoralis major muscle flap for 118 patients with sternal infection after cardiac surgery. Heart, 2013, 99(Suppl 1): 487-492.
11.	Simunovic F, Koulaxouzidis G, Stark GB, et al. Infraareolar pectoralis major myocutaneous island flap as treatment of first choice for deep sternal wound infection. J Plast Reconstr Aesthet Surg, 2013, 66(2): 187-192.
12.	Filsoufi F, Castillo JG, Rahmanian PB, et al. Epidemiology of deep sternal wound infection in cardiac surgery. J Cardiothorac Vasc Anesth, 2009, 23(4): 488-494.
13.	Modrau IS, Ejlertsen T, Rasmussen BS. Emerging role of Candida in deep sternal wound infection. Ann Thorac Surg, 2009, 88(6): 1905-1909.
14.	刘冬, 王文璋, 蔡爱兵. 心脏手术后深部胸骨切口感染修复与重建 189 例临床分析. 中华外科杂志, 2015, 53(3): 193-196.

1. Gummert JF, Barten MJ, Hans C, et al. Mediastinitis and cardiac surgery—An updated risk factor analysis in 10,373 consecutive adult patients. Thorac Cardiovasc Surg, 2002, 50(2): 87-91.
2. Kubota H, Miyata H, Motomura N, et al. Deep sternal wound infection after cardiac surgery. J Cardiothorac Surg, 2013, 8: 132.
3. Singh K, Anderson E, Harper JG. Overview and management of sternal wound infection. Semin Plast Surg, 2011, 25(1): 25-33.
4. Al-Zaru IM, Ammouri AA, Al-Hassan MA, et al. Risk factors for deep sternal wound infections after cardiac surgery in Jordan. J Clin Nurs, 2010, 19(13-14): 1873-1881.
5. Garner JS, Jarvis WR, Emori TG, et al. CDC definitions for nosocomial infections, 1988. Am J Infect Control, 1988, 16(3): 128-140.
6. Juhl AA, Koudahl V, Damsgaard TE. Deep sternal wound infection after open heart surgery—Reconstructive options. Scand Cardiovasc J, 2012, 46(5): 254-261.
7. Deniz H, Gokaslan G, Arslanoglu Y, et al. Treatment outcomes of postoperative mediastinitis in cardiac surgery; negative pressure wound therapy versus conventional treatment. J Cardiothorac Surg, 2012, 7: 67.
8. 王显悦, 王晓武, 毕生辉, 等. 封闭负压引流技术在心脏手术后切口感染治疗中的应用. 中国胸心血管外科临床杂志, 2012, 19(5): 529-533.
9. Schols RM, Lauwers TM, Geskes GG, et al. Deep sternal wound infection after open heart surgery: Current treatment insights. A retrospective study of 36 cases. Eur J Plast Surg, 2011, 34(6): 487-492.
10. Wang W, Cai A. Analysis of surgical treatment with pectoralis major muscle flap for 118 patients with sternal infection after cardiac surgery. Heart, 2013, 99(Suppl 1): 487-492.
11. Simunovic F, Koulaxouzidis G, Stark GB, et al. Infraareolar pectoralis major myocutaneous island flap as treatment of first choice for deep sternal wound infection. J Plast Reconstr Aesthet Surg, 2013, 66(2): 187-192.
12. Filsoufi F, Castillo JG, Rahmanian PB, et al. Epidemiology of deep sternal wound infection in cardiac surgery. J Cardiothorac Vasc Anesth, 2009, 23(4): 488-494.
13. Modrau IS, Ejlertsen T, Rasmussen BS. Emerging role of Candida in deep sternal wound infection. Ann Thorac Surg, 2009, 88(6): 1905-1909.
14. 刘冬, 王文璋, 蔡爱兵. 心脏手术后深部胸骨切口感染修复与重建 189 例临床分析. 中华外科杂志, 2015, 53(3): 193-196.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical treatment of 655 patients with deep chest wall infection: A single-center retrospective analysis

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