Journal Article

Results of the modified bi-pectoral muscle flap procedure for post-sternotomy deep wound infection

Markakis, Charalampos, Moris, Demetrios, Athanasiou, Antonios, Karagkiouzis, Grigorios, Tomos, Periklis, Karakatsani, Anna, Dimitroulis, Dimitrios, Lachanas, Elias, Agathos, E. Andreas, Spartalis, Eleftherios

2016

Overview

PurposePost-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.MethodsThe 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.Results30-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.ConclusionsPectoralis-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.

• Publisher: Springer Nature B.V
• Subject: Algorithms / Debridement / Heart surgery / Infections / Mortality / Patients