title: Chest wall reconstruction for sternal dehiscence after open heart surgery.
abstract: BACKGROUND
  Sternal dehiscence is a grave complication after open heart surgery. Sternal debridement and flap coverage are the mainstays of therapy, but no consensus exists regarding the appropriate level of debridement. More recently, the use of vacuum-assisted closure devices has been advocated as a bridge to definitive closure, but indications for use remain incompletely defined.
  
  
  METHODS
  A retrospective review of all chest wall reconstructions performed from January 2000 to December 2010 was conducted. The type of operative management was evaluated to assess morbidity, mortality, and length of hospital stay.
  
  
  RESULTS
  Fifty-four patients underwent chest wall reconstruction for poststernotomy mediastinitis. Of these patients, 24 underwent conservative sternal debridement with flap closure, 24 underwent radical sternectomy including resection of the costal cartilages followed by flap closure, and 6 underwent radical sternectomy with vacuum-assisted closure therapy followed by flap closure in a delayed fashion. There were 15 patients in the conservative group and 8 patients in the radical sternectomy group who developed postoperative complications (62.5% vs 33.3%, P < 0.05). The conservative sternectomy group had more serious complications requiring reoperation compared to the radical sternectomy group (86.7% vs 25.0%, P < 0.05). The most common complication in the former group was flap dehiscence (8/15, 53.3%), whereas that in the latter group was a superficial wound infection (6/8, 75.0%). There was no significant difference in mortality (25.0% vs 25.0%, P > 0.05%) or length of hospital stay.
  
  
  CONCLUSIONS
  Radical sternectomy including the costal cartilages is associated with lower rates of surgical morbidity and reoperation, but not mortality.
authors.affiliation: Division of Plastic and Reconstructive Surgery, UCLA Medical Center, Los Angeles, CA 90095, USA. eichang@hotmail.com
authors.forename: Eric I
authors.initials: EI
authors.lastname: Chang
authors.forename: Jaco H
authors.initials: JH
authors.lastname: Festekjian
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Miller
authors.forename: Abbas
authors.initials: A
authors.lastname: Ardehali
authors.forename: George H
authors.initials: GH
authors.lastname: Rudkin
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D006801:Humans; D007902:Length of Stay; D008480:Mediastinitis / Q000601:surgery*; D054843:Negative-Pressure Wound Therapy; D011183:Postoperative Complications / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000601:surgery*; D013530:Surgical Wound Infection / Q000601:surgery; D035441:Thoracic Wall / Q000601:surgery*