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

• Published in: Surgery today (Tokyo, Japan) Vol. 46; no. 4; pp. 460 - 465
• Main Authors: Spartalis, Eleftherios, Markakis, Charalampos, Moris, Demetrios, Lachanas, Elias, Agathos, E. Andreas, Karakatsani, Anna, Karagkiouzis, Grigorios, Athanasiou, Antonios, Dimitroulis, Dimitrios, Tomos, Periklis
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.04.2016
• Subjects: Debridement; Female; Follow-Up Studies; Humans; Length of Stay; Male; Mediastinitis - etiology; Mediastinitis - surgery; Medicine; Medicine & Public Health; Original Article; Pectoralis Muscles; Reconstructive Surgical Procedures - methods; Severity of Illness Index; Sternotomy - adverse effects; Surgery; Surgical Flaps; Surgical Oncology; Surgical Wound Infection - etiology; Surgical Wound Infection - surgery; Treatment Outcome; Sternotomy; Post-sternotomy mediastinitis; Bi-pectoral flap
• ISSN: 0941-1291; 1436-2813; 1436-2813
• DOI: 10.1007/s00595-015-1192-5

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.