A new clinical classification and reconstructive strategy for post-sternotomy surgical site infection

Kitano, Daiki; Takahashi, Hiroaki; Nomura, Tadashi; Okada, Kenji; Terashi, Hiroto; Sakakibara, Shunsuke

doi:10.1016/j.reth.2022.10.007

Cited by 3 publications

(6 citation statements)

References 20 publications

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“…In cases of significant inferior sternal loss, a rectus abdominis flap may be required in combination with a pectoralis flap, and the choice of flap depends on the specific characteristics of the patient's DSWI defect. It is important to note that sternal reconstruction using muscle flaps may present challenges, including chronic pain and/or sternal instability, reported in more than 40% of cases, and long-term muscle weakness (5)(6)(7)(8).…”

Section: Discussionmentioning

confidence: 99%

“…This method aims to optimize wound healing and ultimately achieve delayed primary closure, thereby reducing the risk of complications. In addition to NPWT, selecting an appropriate flap for wound coverage is critical in successful DSWI management (5)(6)(7)(8). The choice of the flap is influenced by several factors, including the size of the wound and the patient's specific characteristics.…”

Section: Introductionmentioning

confidence: 99%

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Successful pedicled vertical rectus abdominis myocutaneous flap reconstruction with negative-pressure wound therapy for deep sternal wound infection: a case report and comprehensive review

Lee,

Eo,

Lim

et al. 2023

Front. Surg.

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IntroductionDeep sternal wound infection (DSWI) is a serious complication that may occur after median sternotomy, with potentially devastating consequences. By reporting our case and analyzing the existing literature, this article aimed to provide a thorough understanding of the role of negative-pressure wound therapy (NPWT) and the importance of flap choice in managing DSWI accompanied by severe heart injury and high hemodynamic risk.Case descriptionA 60-year-old woman with severe aortic stenosis, aortic valve regurgitation, and heart failure underwent redo sternotomy, which resulted in an intraoperative right ventricle injury. She required extracorporeal membrane oxygenation support because of low blood pressure and subsequently developed complications, including surgical site hematoma, wound dehiscence, and fat necrosis. She was referred for wound closure, where a significant 10 × 20-cm soft tissue defect in the anterior chest wall was observed. A pedicled vertical rectus abdominis myocutaneous flap addressed the soft tissue defect. The wound showed remarkable improvement at the 8-month follow-up visit.ConclusionsDSWI management is a complex and multifaceted challenge. NPWT, when combined with appropriate surgical strategies, including wound debridement and flap selection, may promote successful wound healing. This case report highlights the successful management of a complex DSWI using a multidisciplinary approach, including debridement, appropriate antibiotic therapy, and free-flap reconstruction, which resulted in favorable outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Successful pedicled vertical rectus abdominis myocutaneous flap reconstruction with negative-pressure wound therapy for deep sternal wound infection: a case report and comprehensive review

Lee,

Eo,

Lim

et al. 2023

Front. Surg.

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“…Si existiera inestabilidad esternal y falta ósea sana, el cierre quirúrgico puede lograrse en última instancia utilizando músculo o colgajos omentales. (61,62,63) Tanto en la mediastinitis necrotizante descendente como en la perforación esofágica, la prioridad, es el tratamiento de la lesión causante con drenaje cervical y mediastínico concurrente y generoso. (64,65,66,67,68,69) El manejo endoscópico de las perforaciones esofágicas o fugas anastomóticas con stents ha sido descrito en la literatura y es una opción aceptable si se dispone de experiencia.…”

Section: Tratamiento Quirúrgicounclassified

Mediastinitis

Litardo Fernández,

López Baños,

Bajaña León

et al. 2024

Afecciones Infrecuentes en La Práctica Quirúrgica

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La mediastinitis es una afección grave, relativamente rara, peropotencialmente mortal, que implicaun proceso de inflamación y/odeinfección de los tejidos y estructuras conectivos contenidos dentro del mediastino. Puede originarseprincipalmenteporla infección profunda de la herida esternal, la perforación esofágica y la mediastinitis necrotizante descendente. Sudiagnósticose basa enelementos clínicos y hallazgos radiológicos. Resulta fundamental identificar los agentes biológicos causantespara realizar una adecuada terapia antimicrobiana. En este sentido, debe considerarse que los gérmenes responsables varían según la localización anatómica, lo cual hace queel tratamiento empírico sea desafiante. La cirugía y las medidas de apoyo deben tener como objetivo reducir el inóculo de patógenos y así proporcionarun desbridamiento y drenaje adecuado. La detección tardíade esta afección se asocia coníndices altos de morbimortalidad.

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“…Subsequent studies showed a mortality rate of 5.1-8.1% and a recurrence of sternal infection of 5.1-44%. Other authors insist on the plastics with a strand of the greater omentum, first described by Lee et al, to cover mediastinal defects, or with a reversed musculus rectus abdominis flap [10,20]. The results of these studies indicate relatively high post-operative survival, although they all carry additional surgical trauma and the risk of further complications.…”

mentioning

confidence: 99%

“…The use of allografts and xenografts in surgery for large chest wall deformities has been documented in the literature [20]. After implantation, the material is progressively revascularized and reshaped in patients' own tissue.…”

mentioning

confidence: 99%

Negative Pressure Wound Therapy in the Treatment of Sternal Infection after Cardiac Surgery: a Case Report and Literature Review

Ivanova,

Kryvoruchko,

Cheverda

et al. 2023

ujcvs

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The aim. To assess the effectiveness of negative pressure wound therapy (NPWT) in the treatment of sternal infection following heart surgery. Materials and methods. During 2019-2022, six patients aged from 46 to 69 years underwent NPWT for sternal infection which occurred within 2 to 24 weeks after complete median sternotomy. For the purpose of temporary wound closure, standard dressing kits with sorption sponge were used. Negative pressure was created by electric vacuum pump with a constant vacuum mode at a range of -75 to -115 mm Hg and a duration of 4-5 days per session. In all cases determination of serum procalcitonin, bacteriological examination of wound discharge, computed tomography (CT) of the chest were performed in dynamics. Results. The study revealed that NPWT in all cases promoted wound cleansing, gradual closing of fistulas and non-grooving pockets, termination of inflammatory process, reduction of the wound cavity, thus accelerating complete wound healing. A significant reduction in the level of wound contamination was revealed after the first NPWT session (below the critical level of 103 CFU), compared to that before treatment (107-108 CFU). Normalization of the level of procalcitonin in the blood serum was determined by day 5-7 of NPWT. CT showed the signs of sternum stability and reduction of inflammatory process in surrounding tissues after treatment. Each treatment case required from 2 to 4 sessions. The duration of hospital stay ranged between 25 and 35 days. A treatment case of one of the 6 patients included in the study is described. Conclusions. NPWT has proven to have positive clinical effect in the local treatment of postoperative sternal infection and can be applied as an ultimate or a transitional option. Methodology of its clinical application needs further elaboration.

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A new clinical classification and reconstructive strategy for post-sternotomy surgical site infection

Cited by 3 publications

References 20 publications

Successful pedicled vertical rectus abdominis myocutaneous flap reconstruction with negative-pressure wound therapy for deep sternal wound infection: a case report and comprehensive review

Successful pedicled vertical rectus abdominis myocutaneous flap reconstruction with negative-pressure wound therapy for deep sternal wound infection: a case report and comprehensive review

Mediastinitis

Negative Pressure Wound Therapy in the Treatment of Sternal Infection after Cardiac Surgery: a Case Report and Literature Review

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