PURPOSE: Post-sternotomy deep sternal wound infection (DSWI) is a severe complication of cardiac surgery. The introduction of omental and muscle flaps has resulted in a significant decrease in morbidity and mortality. In this article, we present the findings for a series of 55 consecutive patients with DSWI treated using an alternative bi-pectoral musculofascial flap technique. METHODS: The patients were stratified into two groups (one-or two-stage intervention). Patients with septic wounds initially underwent debridement and wound treatment, while vacuum therapy was used in a subset of the subjects. All patients were treated with wound debridement and bi-pectoral advancement flap reconstruction. RESULTS: 30-day mortality was 5.4%. Most patients (72%) were treated in two stages, while vacuum therapy was used in 20% of the patients. The mean number of hospitalization days was 8 and 12 for the one- and the two-stage groups, respectively. Reconstruction was successful in all but three patients, each of whom developed recurrent infection. No major morbidity was reported at a mean follow-up of 82 months with excellent functional and aesthetic outcomes. CONCLUSIONS: Pectoralis-major muscle flaps remain relevant in the modern management of post-sternotomy mediastinitis. The addition of an omental flap should be considered in cases in which the lower sternum is involved. Prompt diagnosis and a meticulous surgical technique ensure favorable results for the majority of patients.
PURPOSE: Post-sternotomy deep sternal wound infection (DSWI) is a severe complication of cardiac surgery. The introduction of omental and muscle flaps has resulted in a significant decrease in morbidity and mortality. In this article, we present the findings for a series of 55 consecutive patients with DSWI treated using an alternative bi-pectoral musculofascial flap technique. METHODS: The patients were stratified into two groups (one-or two-stage intervention). Patients with septic wounds initially underwent debridement and wound treatment, while vacuum therapy was used in a subset of the subjects. All patients were treated with wound debridement and bi-pectoral advancement flap reconstruction. RESULTS: 30-day mortality was 5.4%. Most patients (72%) were treated in two stages, while vacuum therapy was used in 20% of the patients. The mean number of hospitalization days was 8 and 12 for the one- and the two-stage groups, respectively. Reconstruction was successful in all but three patients, each of whom developed recurrent infection. No major morbidity was reported at a mean follow-up of 82 months with excellent functional and aesthetic outcomes. CONCLUSIONS: Pectoralis-major muscle flaps remain relevant in the modern management of post-sternotomy mediastinitis. The addition of an omental flap should be considered in cases in which the lower sternum is involved. Prompt diagnosis and a meticulous surgical technique ensure favorable results for the majority of patients.
Authors: Denis A Berdajs; Andrej Trampuz; Enrico Ferrari; Patrick Ruchat; Michel Hurni; Ludwig K von Segesser Journal: Interact Cardiovasc Thorac Surg Date: 2011-03-03
Authors: Steven P Davison; Mark W Clemens; Deana Armstrong; Ernest D Newton; William Swartz Journal: Plast Reconstr Surg Date: 2007-09-15 Impact factor: 4.730
Authors: Antonio Albacete Neto; Pedro S Coltro; Grazielle S Horácio; Ivan R Almeida; Jayme A Farina Junior Journal: Int Wound J Date: 2017-11-24 Impact factor: 3.315
Authors: Abdulwahid M Salih; Zuhair D Hammood; Fahmi H Kakamad; Karzan M Salih; Hiwa O Baba; Hunar A Hassan; Shvan H Mohammed; Goran A Qadir; Hemn A Hassan; Ismael Y Abdullah Journal: Int J Surg Case Rep Date: 2020-06-22
Authors: Grazielle de Souza Horácio; Pedro Soler Coltro; Antonio Albacete; Juliano Baron Almeida; Vinícius Zolezi da Silva; Ivan de Rezende Almeida; Alfredo José Rodrigues; Jayme Adriano Farina Journal: Braz J Cardiovasc Surg Date: 2017 Sep-Oct