Abstract
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.
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Acknowledgments
The authors would like to thank Ms. Myrto Kogevina for editing the manuscript.
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The authors declare that no conflicts of interest exist. They have full control of all primary data and agree to allow the journal to review our data if requested.
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Spartalis, E., Markakis, C., Moris, D. et al. Results of the modified bi-pectoral muscle flap procedure for post-sternotomy deep wound infection. Surg Today 46, 460–465 (2016). https://doi.org/10.1007/s00595-015-1192-5
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DOI: https://doi.org/10.1007/s00595-015-1192-5