Category Archives: Infections

Management of the recurrent sternal wound infection: DISCUSSION (part 2)

Unfortunately, the rectus abdominis musculocutaneous (VRAM) flap chosen as a sole flap to meet our established criteria in seven patients was complicated by four late infections. This could represent a technical problem on our part as the rectus muscle was … Continue reading

Management of the recurrent sternal wound infection: DISCUSSION (part 1)

Long term outcome studies have shown some concern, even with these workhorse flaps, particularly as regards donor site morbidity . Abdominal wall hernias and bulges, usually due to use of a rectus abdominis flap, occur in one-third of patients. Abdominal … Continue reading

Management of the recurrent sternal wound infection: RESULTS (part 2)

There were four perioperative deaths, due to ongoing renal failure in three, and massive bronchopleural hemorrhage in the other. Three others subsequently died after successful discharge, but none as a consequence of persistant sepsis, with a mean follow-up time of … Continue reading

Management of the recurrent sternal wound infection: RESULTS (part 1)

The majority of our patients suffering sternal infections had undergone median sternotomy for coronary artery bypass. Following the wound classification schema of Pairolero and Arnold, no sterile dehiscences (type I) were treated by us. Most (72.4%) were subacute wounds characterized … Continue reading

Management of the recurrent sternal wound infection: MATERIALS AND METHODS (part 3)

Nine months later the patient presented to the emergency room with an abscess at the xiphoid level which spontaneously opened, and drained persistently for two months. A sinogram and computerized tomographic (CT) scan revealed a subcutaneous tract running superiorly to … Continue reading

Management of the recurrent sternal wound infection: MATERIALS AND METHODS (part 1)

All sternal wounds from 1984 to 1994 which required vascularized flap closure were retrospectively reviewed. The initial reason for surgical intervention by the cardiothoracic service was variable in these 29 patients (Table 2). Thirty-two muscle and seven musculocutaneous flaps were … Continue reading

Management of the recurrent sternal wound infection (part 2)

Therefore, any approach devised to treat the infected sternal wound must always consider this inherent risk of recurrence. Any selection process must be parsimonious in nature, using a single muscle whenever possible to not only preserve local function and aesthetics, … Continue reading

Management of the recurrent sternal wound infection (part 1)

The incidence of sternal wound infection following cardiothoracic surgery is relatively miniscule, and certainly not in excess of the general rate of wound infection after most elective operations. Unfortunately, for those so afflicted, this can be a devastating problem due … Continue reading