Ascending aortic cannulation for Stanford type A acute aortic dissection: Another option
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- 作者：Kenji Minatoya ; Matthias Karck ; Eugeniusz Szpakowski ; Wolfgang Harringer ; Axel Haverich
- 关键词：16 ; 17
- 刊名：The Journal of Thoracic and Cardiovascular Surgery
- 出版年：2003
- 出版时间：April 2003
- 年：2003
- 卷：125
- 期：4
- 页码：952-953
- 全文大小：79 K
文摘
Objective: Sternoclavicular joint infections are rare, and their management is controversial. We reviewed our experience with the surgical management of this condition.Methods: From August 1988 to August 2001, 26 patients (16 men and 10 women) were treated surgically for infected sternoclavicular joints. The median age was 56 years (range, 20-77 years). Patients who had a recent previous median sternotomy were excluded.Results: All patients were symptomatic. Pain was present in 21 patients, swelling in 14 patients, fever in 11 patients, and erythema in 9 patients. Associated conditions included recent or ongoing infections in other areas in 12 patients (pneumonia in 4 patients, multiple joint infections in 2 patients, and other in 6 patients) and an indwelling central venous catheter in 1 patient. Five patients had a history of trauma in the region of the joint. Four patients had prior joint incision and drainage. Unilateral sternoclavicular joint resection was done in 18 patients, bilateral resection in 2 patients, and incision and drainage with debridement in 6 patients. Wound culture results were positive in 24 patients, and the most common organism isolated was Staphylococcus aureus (n = 17). Eleven patients had transposition of the ipsilateral pectoralis major muscle to obliterate residual space and to reconstruct the chest wall. Two (7.7 % ) patients had complications, and 1 died (operative mortality, 3.8 % ). Follow-up was complete in all 25 operative survivors and ranged from 2 months to 10 years (median, 25 months). Twenty-one patients are alive without symptoms, infection, or limitations in range of motion. Four patients have died as a result of causes unrelated to their joint infections.Conclusions: Symptomatic sternoclavicular joint infections often require surgical intervention. Surgical resection combined with muscle transposition provides effective long-term outcome.