title: Secondary omental and pectoralis major double flap reconstruction following aggressive sternectomy for deep sternal wound infections after cardiac surgery.
abstract: BACKGROUND
  Deep sternal wound infection after cardiac surgery carries high morbidity and mortality. Our strategy for deep sternal wound infection is aggressive strenal debridement followed by vacuum-assisted closure (VAC) therapy and omental-muscle flap reconstrucion. We describe this strategy and examine the outcome and long-term quality of life (QOL) it achieves.
  
  
  METHODS
  We retrospectively examined 16 patients treated for deep sternal wound infection between 2001 and 2007. The most recent nine patients were treated with total sternal resection followed by VAC therapy and secondary closure with omental-muscle flap reconstruction (recent group); whereas the former seven patients were treated with sternal preservation if possible, without VAC therapy, and four of these patients underwent primary closure (former group). We assessed long-term quality of life after DSWI by using the Short Form 36-Item Health Survey, Version 2 (SF36v2).
  
  
  RESULTS
  One patient died and four required further surgery for recurrence of deep sternal wound infection in the former group. The duration of treatment for deep sternal wound infection in the recent group was significantly shorter than that in previous group (63.4 ± 54.1 days vs. 120.0 ± 31.8 days, respectively; p = 0.039). Despite aggressive sternal resection, the QOL of patients treated for DSWI was only minimally compromised compared with age-, sex-, surgical procedures-matched patients without deep sternal wound infection.
  
  
  CONCLUSIONS
  Aggressive sternal debridement followed by VAC therapy and secondary closure with an omental-muscle flap is effective for deep sternal wound infection. In this series, it resulted in a lower incidence of recurrent infection, shorter hospitalization, and it did not compromise long-term QOL greatly.
authors.affiliation: Department of Surgery, Division of Cardiac Surgery, Yamaguchi University, Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505 Japan.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Akihito
authors.initials: A
authors.lastname: Mikamo
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kurazumi
authors.forename: Ryo
authors.initials: R
authors.lastname: Suzuki
authors.forename: Bungo
authors.initials: B
authors.lastname: Shirasawa
authors.forename: Kimikazu
authors.initials: K
authors.lastname: Hamano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009852:Omentum / Q000637:transplantation*; D010369:Pectoralis Muscles / Q000637:transplantation*; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D056346:Sternotomy; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000601:surgery*; D019616:Thoracic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome