Background Deep sternal wound complications following sternotomy represent a complex challenge. Management can involve debridement, flap reconstruction, and rigid sternal fixation (RSF). We present our 11-year experience in the surgical treatment of deep sternal wound dehiscence using a standardized treatment algorithm. Methods A retrospective review was conducted of all 134 cardiac patients who required operative debridement after median sternotomy at a single institution between October 2007 and March 2019. Demographics, perioperative covariates, and outcomes were recorded. Univariate and subgroup analyses were performed. Results One-hundred twelve patients (83.5%) with a deep sternal dehiscence underwent flap closure and 56 (50%) RSF. Of the patients who underwent flap closure, 87.5% received pectoralis advancement flaps. A 30-day mortality following reconstruction was 3.9%. Median length of stay after initial debridement was 8 days (interquartile range: 5–15). Of patients with flaps, 54 (48%) required multiple debridements prior to closure, and 30 (27%) underwent reoperation after flap closure. Patients who needed only a single debridement were significantly less likely to have a complication requiring reoperation (N = 10/58 vs. 20/54, 17 vs. 37%, p = 0.02), undergo a second flap (N = 6/58 vs. 17/54, 10 vs. 32%, p < 0.001), or, if plated, require removal of sternal plates (N = 6/34 vs. 11/22, 18 vs. 50%, p = 0.02). Conclusion Although sternal dehiscence remains a complex challenge, an aggressive treatment algorithm, including debridement, flap closure, and consideration of RSF, can achieve good long-term outcomes. In low-risk patients, RSF does not appear to increase the likelihood of reoperation. We hypothesize that earlier surgical intervention, before the development of systemic symptoms, may be associated with improved outcomes.

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Severity III/IV ulcers accounted for 33.8% of the discharges, increasing from 32.4% to 35.3% over the time period (p<0.01). Locations were 63.4% sacral, 8.7% lower extremity, 18.9% multiple locations and 9.0% other. Lower extremity ulcers decreased at 2.2% per year, sacral decreased at .03% and multiple locations increased at 6% per year. The most common primary diagnoses were sepsis (19.0%), acute kidney failure (2.9%) and urinary tract infection (2.9%); the most common comorbidities were hypertension (36.1%), arrhythmia (34.3%) and renal failure (30.6%). The average age and proportion female both decreased significantly over the time period (71.0 vs 69.0, p<0.01 and .51 vs .39, p<0.01) with no change in mortality or length of stay.CONCLUSION: Despite preventative efforts and incentives by healthcare systems pressure ulcers are growing in prevalence with increasing severity.