title: Deep sternal osteomyelitis: an algorithm for reconstruction based on wound width.
abstract: Patients with sternum osteomyelitis are transferred to plastic surgery departments for wound coverage. Several options of flap coverage are known; however, various wound diameters need different flaps. In a retrospective study, 135 patients from 2006-2010 with deep sternal wound infections were evaluated. From 2006-2009 various flaps were used for wound coverage, as described in published reports. In 2010 a developed algorithm was used for defect coverage based on wound width using pectoralis muscle flaps or the latissimus dorsi muscle flap. Two groups of patients were analyzed, from 2006-2009 and 2010, and in a matched pair analysis patients with small wound width less than 6 cm, medium wounds widths between 6-12 cm, and large wound width larger than 12 cm. End-point was wound dehiscence larger than 1 cm. Statistical analysis was done by Mann Whitney U-test using the SPSS program. Forty-eight patients were included in the match from a total of 130 study patients. Statistical analysis did not show significant difference in patient population of the two groups. In the group with wound sizes less than 6 cm a significant difference was found when using the algorithm. In the other groups no statistically significant difference was seen; however lesser numbers in wound dehiscence were found. In addition, a significantly lesser length of stay was found in the ICU and length of the hospital stay for all groups treated according to the algorithm. A reduction of costs may be achieved when using the algorithm based on wound size.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Burns.
authors.forename: Christian
authors.initials: C
authors.lastname: Weinand
authors.forename: Weiguo
authors.initials: W
authors.lastname: Xu
authors.forename: Walter
authors.initials: W
authors.lastname: Perbix
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Theodorou
authors.forename: Rolf
authors.initials: R
authors.lastname: Lefering
authors.forename: Gerald
authors.initials: G
authors.lastname: Spilker
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis / Q000601:surgery*; D010369:Pectoralis Muscles / Q000601:surgery / Q000637:transplantation; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013249:Sternum / Q000601:surgery*; D064171:Superficial Back Muscles / Q000601:surgery / Q000637:transplantation; D013524:Surgical Flaps / Q000098:blood supply*; D013529:Surgical Wound Dehiscence / Q000175:diagnosis / Q000601:surgery*; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology