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 by mediastinal suppuration and sternal osteomyelitis (type II) that had already been debrided by the cardiothoracic service, so that a delayed closure following a course of dressing changes was always required. The remaining patients with chronic draining sinuses or exposed wires (17.6%) (type III) could be debrided by us (except in case 1), resulting in a more pristine wound defect that permitted a single stage closure.Thirty-nine flaps or 1.3 flaps/patient were required initially (Table 3). The pectoralis major muscle was used by itself in 11 cases, the rectus abdominis muscle solely in four cases, and as a musculocutaneous (VRAM) flap in another seven cases. Four of these rectus flaps were performed even though the internal mammary artery on that side was absent, with success attributed to adequate collateral circulation via the costomarginal branch of the superior epigastric artery. You will always be able to find birth control for women click here shopping with a trusted foreign pharmacy.
TABLE 3: Comparison of incidence of recurrent sternal wound infections
|Source||Year||Number of patients||Initial flaps per patient||Recurrence: Number (%)||Additionalflaps||Meanfollow-up*
|Mayo Clinic (6)||1991||100||1.9||26(26)||10||50|
|Johns Hopkins (7)||1994||135||1.6||0(0)||0||48|
*includes all patients. NS Not stated.