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• W2336704029 abstract "Background:It's rare to see major infection of sternal wound after median sternotomy in cardiac surgery which yet may seriously affect the post-operation course including the morbidity, hospital stay, cost, and mortality. Various management strategies have been reported for the sternal wound care including debridement plus rewiring, open wound care, continuous irrigation, Redon tube closed irrigation, open packing then delayed closure, topical negative pressure dressing, and flaps reconstruction. All recent studies share one common principle, that is, adequate debridement of the infected tissue and covering of the defect with well-vascularized tissue.Aim and Objectives:Here we present our treatment strategy for the deep sternal wound infection (DSWI) involving the sternal bone or mediastinal space at Kaohsiung Medical University Hospital in the past ten years.Materials and Methods:From September 2001 to September 2011, 1732 sternotomies were performed at Kaohsiung Medical University Hospital. We identified 41 patients who had suffered from deep sternal wound infection and were referred to plastic department for further treatment.Result:Total 41 patients adopted the surgical reconstruction in our hospital. All patients accepted the extensive debridement and topical negative pressure therapy first. Eight (19.50/0) of them received delay closure. Twenty-one (51.2%) patients with the defect limited to the upper and middle third of the sternum received the pectoralis major muscle (PM) advance flap reconstruction. Seven (17.1%) patients with the defect limited to the lower third of sternum received the rectus abdominis musde (RAM) flap (3), PM turnover flap (2), and PM plus RAM bi-pedicle flap (2) reconstruction. The rest five (12.2%) patients with the defect, involving whole sternum, received the PM plus RAM bi-pedicle flap (3) and Omentum flap (2) reconstruction.One patient got partial wound dehiscence post PM plus RAM bi-pedicle flap due to Mycobacterium tuberculosis infection. The dehiscent lesion got stable and healed after systemic and local anti-tuberculous treatment. Among all the 41 patients, four patients expired during their hospital stay. Three of them who had received the debridement, topical negative pressure dressing, and delay wound closure died of heart failure, and one case with PM advance flap died of sepsis, mediastinitis related.Conclusion:Adequate debridement, local infection control, and wound repair with well vascularized tissue are the keys to successful reconstruction. We prefer to use the PM flap to treat the DSWI. The PM flap is versatile, and 68.3% of the patient with DSWI in KMU hospital were treated with PM based flap including PM advance or turnover flap and PM plus RAM flap. However, the flap design should depend on the patient's status individually." @default.
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• W2336704029 date "2012-03-01" @default.
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• W2336704029 title "Reconstruction of the Post Cardiac Surgery Deep Sternal Wound Infection-a Review of 10 Years KMUH Experience" @default.
• W2336704029 doi "https://doi.org/10.7096/tjtsps.201203.0001" @default.
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