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ORIGINAL ARTICLE

Sternal infections after myocardial revascularization: treatment by myocutaneous and muscle flaps

Rubens T. de BarrosI; Mauro A. de MarchiII; Fábio V Guimarães FilhoI; Wesley F. da SilveiraI; Hugo V. C JimenezIII; Antônio Penna JúniorI

DOI: 10.1590/S0102-76381989000200004

ABSTRACT

During the period of October 1986 to January 1989 we executed 445 sternotomies; 158 of these were for myocardial revascularization. In 92 cases the left internal mammary artery (LIMA) was used. Of 445 cases, 7 patients developed sternal infection in the immediate post operative period. The average time for the infection to appear was 8.7 days (4-15 days). Of these, 6 patients were male with an average age of 48.8 years (35-60 years). All cases were first operations; complicating factors were diabetes (1 case), pulmonic emboly with respiratory insufficiency (1 case), low output syndrome (3 cases), prolonged surgery (1 case) and LIMA dissection (6 cases). With the use of plastic surgery techniques and myocutaneous and muscular flaps, complications were corrected and permitted a more rapid patient recovery, avoiding deaths in this period. The esthetic and functional results were considered excellent. Three small dehiscences were treated in the out-patient clinic. Also of great importance was the identification of the germes by cultures and the treatment based on antibiograms in conjunction with the surgical techniques aplied. In conclusion, we judged that in sternal infections, rapid and aggressive surgery avoided deaths.

RESUMO

No período de outubro de 1986 a janeiro de 1989, realizamos 445 esternotomias, sendo 158 para revascularização do miocárdio; em 92 pacientes, a artéria mamária interna esquerda (AMIE) foi utilizada. Dos 445 casos, sete pacientes tiveram infecção do esterno no período pós-operatório imediato. O tempo médio de aparecimento foi de 8,7 dias (4-15 dias), sendo que seis pacientes eram do sexo masculino e a idade média foi de 48,8 anos (35-60 anos). Em todos os casos, os pacientes estavam sendo submetidos à primeira cirurgia, tendo como possíveis fatores associados diabete (um caso), embolia pulmonar com insuficiência respiratória (um caso), síndrome de baixo débito (três casos), cirurgia prolongada (um caso) e dissecção da AMIE (seis casos). Na correção desta complicação, a associação de técnicas de cirurgia plástica, com a utilização de retalhos miocutâneos ou musculares, permitiu mais rápida recuperação dos pacientes, sem que tivéssemos óbitos nesta série. Os resultados estético e funcional foram considerados excelentes, com três pequenas deiscências tratadas ambulatorialmente. A identificação do germe através de cultura e a orientação do tratamento pelo antibiograma também se mostraram de grande importância, ao lado das técnicas cirúrgicas empregadas. Concluindo, julgamos que a intervenção precoce e agressiva nas infecções do esterno contribuiu, efetivamente, na queda da morbi-mortalidade desta complicação.
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