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, but also assure the greatest diversity of future choices). A schema for the prioritizing of available flap options in anticipation of a possible recurrence should, at least on an intellectual level, be devised by the involved surgeon, as we have attempted here (Table 1). You will always be offered Xopenex Inhaler Dosage at our place at the pharmacy you can trust.
TABLE 1: Sternal closure flap priorities

Initial Recurrent
Intact IMA
1.    Unilateral pectoralis major*

2.    Unilateral rectus abdominis

1.    Readvancement of ‘initial’ flap

2.    Opposite pectoralis major

3.    Unilateral rectus abdominis

4.    Other**

Unilateral absent IMA
1.    Ipsilateral pectoralis major – rotation

2.    Contralateral rectus abdominis

1.    Readvancement of ‘initial’ flap

2.    Contralateral pectoralis major

3.    Contralateral rectus abdominis

4.    Other

Bilateral absent IMA
1.    Unilateral pectoralis major – rotation

2.    Unilateral rectus abdominis -costomarginal collaterals

1.    Readvancement of ‘initial’ flap

2.    Opposite pectoralis major – rotation

3.    Unilateral rectus abdominis -costomarginal collaterals

4.    Other

*IMA Internal mammary artery. 1 Primary choice, 2 Secondary, etc.*Unless specified, pectoralis muscle can be used either as a rotation-advancement flap (thoracoacromial pedicle) or turnover (segmental IMA perforator). **Other flaps include omentum or latissimus dorsi, external oblique, or bipedicle pectoralis major-rectus abdominis muscles depending on availability

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