Negative-pressure wound therapy and laparoscopic omentoplasty for deep sternal wound infections after median sternotomy.
Deep sternal wound infection remains one of the most serious complications in patients who undergo median sternotomy for coronary artery bypass surgery.We describe our experience in treating 6 consecutive patients with our treatment protocol that combines aggressive débridement, broad-spectrum antibiotics, negative-pressure wound therapy, omentoplasty with laparoscopically harvested omentum, and the use of bilateral pectoral muscle advancement flaps.The number of débridements needed in order to attain clinically clean wounds and negative cultures varied between 1 and 10, with a median of 5. The length of stay after omentoplasty and bilateral pectoral muscle advancement flap placement varied between 11 and 22 days. One of the 6 patients developed a small wound dehiscence that was treated conservatively. No bleeding related to vacuum-assisted closure therapy was identified. Three patients had pneumonia. Two of the 3 patients had an episode of acute renal failure. The 30-day mortality rate was zero, although 1 patient died in the hospital 43 days after the reconstructive surgery, of multiple-organ failure due to pneumonia that was induced by end-stage pulmonary fibrosis. No patient died between hospital discharge and the most recent follow-up date (4-12 mo). Late local follow-up results, both functional and aesthetic, were good.We conclude that negative-pressure wound therapy-in combination with omentoplasty using laparoscopically harvested omentum and with the use of bilateral pectoral advancement flaps-is a valuable technique in the treatment of deep sternal wound infection because it produces good functional and aesthetic results.
Departments of General and Abdominal Surgery, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium. kristof.de.brabandere@gmail.com
Kristof
K
De Brabandere
Daniel
D
Jacobs-Tulleneers-Thevissen
Jens
J
Czapla
Mark
M
La Meir
Georges
G
Delvaux
Francis
F
Wellens
D058186:Acute Kidney Injury / Q000209:etiology; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001530:Belgium; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D003646:Debridement; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D007902:Length of Stay; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000009:adverse effects / Q000401:mortality; D009852:Omentum / Q000601:surgery*; D010369:Pectoralis Muscles / Q000601:surgery; D011014:Pneumonia / Q000209:etiology; D056346:Sternotomy / Q000009:adverse effects* / Q000401:mortality; D013524:Surgical Flaps / Q000009:adverse effects; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000382:microbiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents