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 all survivors of 37.4 months. Six patients had recurrence of a sternal infection at a mean of 7.4 months following their median sternotomy for coronary artery bypass graft. Five had residual osteomyelitis identified by bone scan. The cause in one patient remains unknown (case 2). Four resolved with wound drainage or local treatment and culture specific antibiotics. Two required extensive further debridement and additional muscle flap coverage (case reports). No further recurrences in this subset have been observed.
Emphasis for treatment of the infected sternal wound, following adequate debridement, has basically centered about the use of muscle flaps as a direct consequence of the dramatic successes obtained when compared to earlier methods. The pectoralis major muscle remains the most versatile choice when based on its dominant thoracoacromial pedicle, although function preservation techniques using turnover or segmental split flaps can be valuable for some smaller defects if the corresponding internal mammary artery has not been violated. Restricted by this same constraint, the rectus abdominis muscle has been important for filling the lower third of these sternotomy defects, and rarely should be expected to accomplish more, although a vertical musculocutaneous (VRAM) flap version can be extended to reach most wounds in their entirety as a single flap. You will always enjoy getting Xopenex for Asthma click here, being 100% sure you are safe.
Tags: Median sternotomy, Muscle flaps, Sternal wound infection