Immediate versus delayed one-stage sternal débridement and pectoralis muscle flap reconstruction of deep sternal wound infections.
BACKGROUND
The management of postoperative deep sternal wound infection varies widely based on the discretion of the cardiovascular surgeon and the plastic surgeon.


METHODS
Analysis of patients with deep sternal wound infection undergoing one-step radical sternal débridement and muscle flap reconstruction by a single plastic surgeon from 1986 to 2008 was conducted. Two groups of patients were identified. The immediate group was referred soon after diagnosis of sternal wound infection and without any débridement. The delayed group was referred much later after undergoing an extended management by their cardiovascular surgeon. Retrospective review was performed to compare morbidity, mortality, and length of stay between the two groups.


RESULTS
There were a total of 583 patients with deep sternal wound infection. Of the 497 patients referred immediately, 22 (4.4 percent) patients required mechanical ventilation for an average of 4 days, eight (1.6 percent) required tracheotomy, 13 (2.6 percent) developed stage III/IV pressure sores, 24 (4.8 percent) developed major wound dehiscence, zero (0 percent) required skin grafting, average length of stay was 4.7 days, and five died (1 percent). Of the 86 patients with a delayed referral, 40 (46.5 percent) required mechanical ventilation for an average of 18.3 days, 31 (36 percent) required tracheotomy, 20 (23.3 percent) developed stage III/IV pressure sores, 12 (14 percent) developed major wound dehiscence, nine (10.5 percent) required skin grafts, the average length of stay was 19.3 days, and four died (4.7 percent).


CONCLUSIONS
Patients with deep sternal wound infection following sternotomy benefit from one-step radical sternal débridement and muscle flap(s) reconstruction, as it results in a significant decrease in morbidity, mortality, and length of stay.
Cabbabe
Edmond B
EB
St. Louis, Mo.; and Birmingham, Ala. From St. Louis University and the Division of Plastic Surgery, University of Alabama at Birmingham.
Cabbabe
Samer W
SW
D003646:Debridement / Q000379:methods*; D006801:Humans; D010369:Pectoralis Muscles / Q000637:transplantation*; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery*; D013908:Thoracotomy / Q000009:adverse effects*; D013997:Time Factors