title: Long-term results of flap reconstruction in median sternotomy wound infections.
abstract: Reconstruction of infected median sternotomy wounds using muscle and omental flaps has been shown to result in significantly reduced morbidity, mortality, and length of hospital stay. Despite these benefits, very little is known about the potential long-term sequelae of such procedures. The purpose of this study was therefore to evaluate the ultimate functional outcome in such patients. One-hundred and thirty-three consecutive patients underwent debridement and flap reconstruction of their infected median sternotomy wounds over an 8-year period. Eighty patients were available for follow-up and responded to a questionnaire. Forty-eight patients consented to a physical examination. The length of follow-up ranged from 15 to 108 months (average 48 months). Healed wounds were obtained in 99 percent of patients. Fifty-one percent of patients noted persistent pain or discomfort, particularly in the chest and shoulder. Forty-four percent noted areas of numbness/paresthesias, mainly on the chest. Thirty-four patients (42.5 percent) noted symptoms of sternal instability; of those consenting to an examination, 45 percent were confirmed to have instability. Twenty-six patients (32.5 percent) claimed postoperative weakness (shoulder/abdomen). Significant shoulder weakness was not demonstrated; however, abdominal weakness was substantial. Thirty-six percent of patients reported an inability to perform the same preoperative activities that were of importance to them (sports, housework, etc.). Of those patients eligible to return to work, 52 percent did not. Patients younger than age 60 had a somewhat higher chance of not returning to work. Scars were noted to be good to excellent in 75 percent, but contour abnormalities of the chest and abdomen were found in 85 percent.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Division of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: P R
authors.initials: PR
authors.lastname: Ringelman
authors.forename: C A
authors.initials: CA
authors.lastname: Vander Kolk
authors.forename: D
authors.initials: D
authors.lastname: Cameron
authors.forename: W A
authors.initials: WA
authors.lastname: Baumgartner
authors.forename: P N
authors.initials: PN
authors.lastname: Manson
mesh_terms: D000009:Abdominal Muscles / Q000637:transplantation; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D003646:Debridement; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery*; D013524:Surgical Flaps / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000601:surgery*; D016896:Treatment Outcome