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 to risks of generalized sepsis, uncontrolled hemorrhage or thrombosis, or seeding of prosthetic devices. Survival has increased over the years paralleling the evolution in treatment from open dressings, closed methods with suction drainage, to the intrathoracic transfer of extrathoracic vascularized flaps which presently have become the standard for severe deep mediastinal infections.The use of muscle flaps has substantially reduced mortality, morbidity and length of hospital stay when compared with earlier approaches.
The ultimate effectiveness of local vascularized flaps for sternal wound closure, including donor site morbidity, has had limited study on a long term basis. One large experience from the Mayo clinic had an astonishing 26% rate of recurrence of wound infections, requiring additional flap coverage in 40% of those. Further recurrence in 25% of these latter patients necessitated a third flap in 60%. Although the same flap was re-elevated whenever possible, the remaining options were severely limited. Take advantage of this chance to find Xopenex Inhaler checkout now and save quite some money.
Tags: Median sternotomy, Muscle flaps, Sternal wound infection