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 needed, most often following debridement by the cardiothoracic surgeon. There were four perioperative deaths, but none due to persistant mediastinal sepsis. Three patients died long after discharge. Six patients (20.7%) developed a recurrent sternal infection and two of these required transfer of an additional muscle flap before obtaining ultimate healing. One hundred percent of patients discharged after their closure by a muscle flap transfer eventually obtained a healed wound. Visit the best pharmacy giving you Xopenex Price click here and taking the best care of you.
TABLE 2: The cardiothoracic service

Etiology
Median sternotomy
Coronary artery bypass 23
Valve replacement 4
Metastatic osteomyelitis 2
Total patients 29
Wound class
Type I (acute) 0
Type II (subacute) 21
Type III (chronic) 8
Flap selection
Pectoralis major muscle
Rotation-advancement 18
Turnover 3
Rectus abdominis:
Muscle (IMA intact) 7
Muscle (IMA absent) 4
VRAM 3
De-epithelialized VRAM 4
Other none
Total flaps 39
Mortality
Perioperative 4
During follow-up period 3
Infection recurrence
Source
Osteomyelitis 5
Unknown 1
Initial wound
Type II 5
Type III 1
Mean onset 7.4 months
Total patients 6

*Entire experience from 1984 to 1994. fCriteria per Pairolero and Arnold  as described in Results. IMA Internal mammary artery; VRAM Vertical rectus abdominis musculocutaneous flap

 

This entry was posted in Infections and tagged Median sternotomy, Muscle flaps, Sternal wound infection.