Reconstruction of Infected Median Sternotomy Wounds

Cohen, Mimis; Silverman, Norman A.; Goldfaden, Daniel M.

doi:10.1001/archsurg.1987.01400150077015

Cited by 18 publications

(3 citation statements)

References 16 publications

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“…Sternotomy wound breakdown following cardiac surgery is an uncommon but serious event that can leave significant defects, often exposing the mediastinum. 1 A common cause is wound infection, but occasionally mechanical dehiscence of the skin can occur, particularly in conditions involving increased chest wall excursion (eg, patient struggling to breathe). The standard first line of management is surgical debridement, followed by the removal of sternal wires, if necessary.…”

Section: Perspectivementioning

confidence: 99%

The internal mammary artery perforator flap and its subtypes in the reconstruction of median sternotomy wounds

Kannan

2016

The Journal of Thoracic and Cardiovascular Surgery

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The IMAP flap has an advantage in its the ability to reconstruct the entire length of a sternotomy wound from the suprasternal notch to the xiphisternum with relatively minimal dissection and morbidity compared with more conventional flaps such as pectoralis major, rectus, and omental flaps. Nevertheless, caveats for its use remain, such as in patients with vasopressor therapy and the resulting subclavicular scar, which is unaesthetic in women. Overall, the IMAP flap is an attractive reconstructive tool specifically in stable male patients with noninfected sternotomy wound dehiscence with a defect width of up to 7 cm. In this patient subset, it is the ideal first-line reconstructive tool.

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Section: Perspectivementioning

confidence: 99%

The internal mammary artery perforator flap and its subtypes in the reconstruction of median sternotomy wounds

Kannan

2016

The Journal of Thoracic and Cardiovascular Surgery

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“…18 The rectus abdominis or omentum must then be sacrificed to fill in the lower pole of the wound. 16 " 20 Upper extremity weakness after harvesting the pectoralis major muscle for sternal wound closure has also been reported in about 25 percent of patients. 2125 In addition, use of the pectoralis also leaves a hollow contour deformity in the subclavicular area.…”

Section: Discussionmentioning

confidence: 99%

“…However, often two or three sources of tissue may be required to cover large wounds. 16 " 20 The rotation of local or regional muscle or omentum into the sternal wound may not be feasible because of the lack of a good vascular pedicle. Previous abdominal surgeries can lead to adhesions of the omentum, excluding its use.…”

mentioning

confidence: 99%

Use of Free‐Tissue Transfer in the Treatment of Median Sternotomy Wound Infections: Retrospective Review

Brown¹,

McCall²,

Neumeister³

1999

J reconstr Microsurg

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The incidence of sternal wound infection following median sternotomy is 0.4 to 5 percent. Debridement and closure of the wounds with local and regional muscles, such as a pectoralis or a pedicled rectus abdominis, have been the mainstay of surgical treatment. Often, both pectoralis major muscles and the superior portion of a rectus abdominis muscle must be used to close large sternal wounds. Loss of these major muscles can be both debilitating and cosmetically disfiguring. Free-tissue transfer can be employed to limit the amount of tissue needed to fill the sternal defect. The authors present a series of 12 free-tissue transfers used in 11 patients to close large sternal defects in this subset of patients. Total flap loss occurred in one patient. Partial loss of the skin island was noted in three patients. Two patients developed abdominal hernias after rectus abdominis free flaps. Free-tissue transfer offers the ability to close these large wounds, using one muscle, in those patients where pedicled rectus abdominis flaps are not available.

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