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European Journal of Plastic Surgery

, Volume 34, Issue 6, pp 487–492

First Online: 12 April 2011Received: 15 December 2010Accepted: 16 March 2011

Abstract

The aim of this study was to retrospectively evaluate the results of reconstructing infected post-sternotomy wounds, with either sternal plating and-or pectoralis major flap transposition or pedicled omentoplasty after previous vacuum-assisted closure VAC therapy. Between January 2005 and December 2010, 36 patients, suffering from deep sternal wound infection DSWI after coronary artery bypass grafting procedure, received plastic reconstructive surgery. All patients, treated in the Maastricht University Medical Centre Departments of Plastic Surgery and Cardiothoracic Surgery, were selected for this study. For 22 patients, sternal refixation and reconstruction were obtained by sternal internal plate fixation combined with bilateral pectoralis major advancement flap. In 11 patients, a pedicled omentoplasty was performed, with or without split-skin graft and additional VAC therapy. Three patients only received a pectoralis plasty. We evaluated preoperative characteristics and post-operative course. Twenty-four patients 66.7% had an uneventful post-operative course. Complications in the other patients included wound dehiscence, herniation of the donor site and infection of sternal plating material. Average sternal wound healing after sternal plating plus pectoralis plasty, pectoralis plasty and omentoplasty respectively accounted 7.7, 8.0 and 11.6 weeks. From our experience, we recommend VAC therapy plus delayed sternal plating and additional bilateral pectoralis major flap advancement as first repair option in case of DSWI. However, individual clinical conditions need to be taken into account when making a decision between the different available reconstructive options. Omentoplasty should be reserved for cases in which the sternum has recurrently fallen open after previous sternal plate refixation, or for cases in which the sternum defect is too extended.

KeywordsDeep sternal wound infection VAC therapy Sternal plating Pedicled omentoplasty Pectoralis major flap advancement  Download fulltext PDF



Author: Rutger M. Schols - Thomas M. A. S. Lauwers - Gijs G. Geskes - René R. W. J. van der Hulst

Source: https://link.springer.com/







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