Extended sternoclavicular joint infections in cirrhotic patients: staged interdisciplinary approach with thoracic and plastic surgery

Abstract

Aim: Sternoclavicular joint infection associated with liver cirrhosis is an uncommon condition and the optimal surgical treatment is undefined.Methods: Patients and methods: we retrospectively analysed data from six patients with sternoclavicular joint infections and liver cirrhosis underwent between February 2008 and May 2018 a staged therapy using negative pressure therapy followed by secondary "en bloc" joint resection and a pectoralis muscle flap (PMF) obliteration of the thoracic wall defect.Results: Four patients successfully underwent a transfer of the PMF. The surgical revision was required for relevant bleeding in one and a tracheostomy was performed due to the prolonged intubation in another case. One patient died on the fifth day after surgery due to a cerebral septic embolic ischemia and aortic endocarditis. Conclusion:The presence of liver insufficiency and coagulopathy was associated with an extensive blood product demand and required a well-balanced interdisciplinary management. During the follow-up only a minimal restriction in the shoulder mobility was observed.