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Mimis Cohen, MD; Norman A. Silverman, MD; Daniel M. Goldfaden, MD

Arch Surg. 1987;122(3):323-327.

Abstract
• 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 débridement 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.

(Arch Surg 1987;122:323-327)

Author Affiliations
From the Divisions of Plastic and Reconstruction Surgery (Dr Cohen) and Cardiothoracic Surgery (Drs Silverman, Goldfaden, and Levitsky), University of Illinois College of Medicine and West Side Veterans Administration Medical Center, Chicago.

Footnotes
Accepted for publication Sept 19, 1986.

Read before the Tenth Annual Surgical Symposium of the Association of Veterans Administration Surgeons, Washington, DC, May 8, 1986.

Reprint requests to Division of Plastic and Reconstruction Surgery, University of Illinois College of Medicine, 840 S Wood St, Chicago, IL 60612 (Dr M. Cohen).

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