Poststernotomy wound Management by Debridement and Pedicle Flaps Reconstruction
N. Antohi, V. Stan, C. Huian, S. NaeOriginal article, no. 5, 2014
Background: Sternal wound infection and sternal dehiscenceare very serious, sometimes life-threatening complications ofcardiac surgery, which require immediate attention. Themortality rate can reach 50%. During the past 30 years,various flaps for coverage of sternal wounds have beendescribed.Objective: The authors objective was to evaluate their 7-yearexperience with flaps used for coverage of poststernotomywounds, with an emphasis on flap selection and postrepaircomplications.
Results: The records of 15 patients were reviewed. The mostcommon coverage techniques were pectoralis major flap (n=5)and rectus abdominis flap (n=4). Four patients had both ofthese flaps. One patient had a latissimus dorsi flap, andanother one had an omental flap. Eight of the 15 patientsexperienced a local complication; these included seroma(n=2), hematoma (n = 1), infection requiring debridementand antibiotics (n = 2), partial flap necrosis (n = 2) andabdominal hernia (n=1). The perioperative mortality rate was 13.3% (n = 2), and all deaths were attributable to multipleorgandeficiency due to sepsis.
Conclusions: Early debridement and coverage of the remaineddefects with flaps are the two main principles in the managementof poststernotomy infected wounds, especially insituations where rapid wound healing and recovery areextremely important. Individual approach to each patient andproper selection of the method of reconstruction significantlyreduces the postoperative morbidity and mortality rate.
Results: The records of 15 patients were reviewed. The mostcommon coverage techniques were pectoralis major flap (n=5)and rectus abdominis flap (n=4). Four patients had both ofthese flaps. One patient had a latissimus dorsi flap, andanother one had an omental flap. Eight of the 15 patientsexperienced a local complication; these included seroma(n=2), hematoma (n = 1), infection requiring debridementand antibiotics (n = 2), partial flap necrosis (n = 2) andabdominal hernia (n=1). The perioperative mortality rate was 13.3% (n = 2), and all deaths were attributable to multipleorgandeficiency due to sepsis.
Conclusions: Early debridement and coverage of the remaineddefects with flaps are the two main principles in the managementof poststernotomy infected wounds, especially insituations where rapid wound healing and recovery areextremely important. Individual approach to each patient andproper selection of the method of reconstruction significantlyreduces the postoperative morbidity and mortality rate.
