Infection of a median sternotomy wound is a rare albeit potentially fatal complication because of the risk of mediastinitis and deep sternal wound infection. Current treatment of deep sternal wound infection comprises antibiotics, debridement and transposition of muscle or omental flaps to fill the anterior mediastinal dead space.
A retrospective analysis of the deep sternal wound infections treated in our unit over a nine-year period was performed.
Out of the 11 903 consecutive coronary artery bypass graft procedures performed, 27 patients were referred to plastic surgery for management of deep sternal wound infection with flaps. Wounds were classified based on their location on the sternum as type A (upper ½), B (lower ½) or C (whole of sternum). Five patients had type A wounds, 12 type B wounds and 10 type C wounds. The mean age was 68 years and the M:F ratio was 20:7.
We describe guidelines for the choice of flap for sternal wound reconstruction, according to the anatomical site of the wound dehiscence.
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- The median sternal incision in intracardiac surgery with extracorporeal circulation: a general evaluation of its use in heart surgery.Surgery. 1957; 42: 753
- Mediastinal infection after cardiac surgery.Ann Thorac Surg. 1984; 38: 415-423
- Results of omental flap transposition for deep sternal wound infection after cardiovascular surgery.Ann Surg. 1998; 227: 455-459
- Management of infected median sternotomy wounds.Ann Thorac Surg. 1986; 42: 1-2
- Wound complications after median sternotomy: relationship to internal mammary grafting.J Thorac Cardiovasc Surg. 1989; 98: 1096-1099
- Median sternotomy wound dehiscence: a retrospective case control study of risk factors and outcome.J R Coll Surg Edinb. 1992; 37: 305-308
- Mediastinitis after cardiac valve operations: impact on survival.J Thorac Cardiovasc Surg. 1985; 90: 517-522
- Sternal wound infections and use of internal mammary artery grafts.J Thorac Cardiovasc Surg. 1991; 102: 342-347
- Factors predisposing to median sternotomy complications.Chest. 1996; 110: 1173-1178
- Bilateral internal mammary artery grafts in reoperative and primary coronary bypass surgery.Ann Thorac Surg. 1991; 52: 20-28
- Sternal wound complications after open-heart surgery: results from 3524 consecutive operative procedures.Contemp Surg. 1993; 43: 197-202
- Continuous antibiotic irrigation in the treatment of infection.Arch Surg. 1963; 86: 384-387
- Total excision of the sternum and thoracic pedicle transposition of the greater omentum; useful strategems in managing severe mediastinal infection following open heart surgery.Surgery. 1976; 80: 433-436
- Infected median sternotomy wound. Successful treatment by muscle flaps.Ann Surg. 1980; 191: 738-744
- Management of the infected median sternotomy wound with muscle flaps. The Emory 20-year experience.Ann Surg. 1997; 225: 766-776
- Muscle flap reconstruction for the treatment of major sternal wound infections after cardiac surgery: a 10 year analysis.Scand J Plast Reconstr Surg Hand Surg. 1999; 33: 17-24
- Management of deep sternal wound infection after cardiac surgery–Hanuman syndrome.Scand J Thorac Cardiovasc Surg. 1991; 25: 111-117
- Primary treatment of the infected sternotomy wound with muscle flaps: a review of 211 consecutive cases.Plast Reconstr Surg. 1989; 84: 434-441
- An island flap of the pectoralis major muscle.Br J Plast Surg. 1977; 30: 161-165
- New reconstruction method for sternotomy wounds.Perspecives in Plast Surg. 1994; 8: 61-65
- Bipedicle muscle flaps in sternal wound repair.Plast Reconstr Surg. 1998; 101: 356-360
- Chest-wall reconstruction: an account of 500 consecutive patients.Plast Reconstr Surg. 1996; 98: 804-810
Published online: January 22, 2007
Accepted: October 15, 2006
Received: January 9, 2006
☆This paper was presented at the British Association of Plastic Surgeons Summer Scientific Meeting, Newport, 2 July 2003. There are no financial interests associated with this paper and no sources of funding.
© 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.