Reconstruction of infected median sternotomy wounds
M. Cohen, N. A. Silverman, D. M. Goldfaden and S. Levitsky
Infected median sternotomy represents a major complication of cardiac
surgery, with significant morbidity and mortality. The treatment of choice
is immediate drainage and closure over suction irrigation catheters.
However, when this conservative approach fails or radical debridement makes
primary closure impossible, muscle flap closure is indicated. This form of
reconstruction facilitates the obliteration of large mediastinal wounds;
prevents spreading of infection on the heart, suture lines, grafts, or
prosthetic material; and significantly decreases morbidity and mortality.
We performed muscle flap closure in 11 consecutive patients in whom
conservative treatment of infected median sternotomy wounds failed. All
patients required closure with at least two muscle flaps or omentum for the
complete obliteration of the mediastinal wounds. There was one
postoperative death in our series due to acute heart failure. There were
two superficial skin losses requiring skin grafting and one persistent
draining sinus after reconstruction. Based on our experience and that of
others, we conclude that muscle flap reconstruction should be considered as
an important technique for the reconstruction of infected median sternotomy
wounds.
