title: Risk factors for complications after reconstructive surgery for sternal wound infection.
abstract: BACKGROUND
  Although the utility of flaps for the treatment of sternal wound infections following median sternotomy has been reported for 30 years, there have been few reports on the risk factors for complications after reconstruction. The objective of this investigation was to identify factors related to complications after the reconstruction of sternal wound infections.
  
  
  METHODS
  A retrospective analysis of 74 patients with reconstructive surgery after sternal wound infection over a 5-year period was performed. Clinical data including age, sex, body mass index (BMI), comorbidities, bacterial culture, previous cardiac surgery, wound depth, mortality rate, type of reconstructive procedure, and complication rate were collected.
  
  
  RESULTS
  The patients' BMI ranged from 15.2 to 33.6 kg/m(2) (mean, 23.1±3.74 kg/m(2)). Wound closure complications after reconstructive surgery were observed in 36.5% of the cases. The mortality rate was 2.7%. Diabetes mellitus significantly affected the rate of wound closure complications (P=0.041). A significant difference in the number of complications was seen between Staphylococcus aureus (S. aureus) and coagulase-negative Staphylococci (P=0.011). There was a correlation between harvesting of the internal thoracic artery and postoperative complications (P=0.048). The complication rates of the pectoralis major flap, rectus abdominis flap, omentum flap, a combination of pectoralis major flap and rectus abdominis flap, and direct closure were 23.3%, 33.3%, 100%, 37.5%, and 35.7%, respectively.
  
  
  CONCLUSIONS
  Diabetes mellitus, S. aureus, harvesting of the internal thoracic artery, and omentum flap were significant factors for complications after reconstruction. The omentum flap volume may be related to the complications associated with the omentum flap transfer in the present study.
authors.affiliation: Department of Plastic and Reconstructive Surgery, The University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Hashimoto
authors.affiliation: Department of Plastic and Reconstructive Surgery, The University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Takaku
authors.affiliation: Department of Plastic and Reconstructive Surgery, The University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Matsuo
authors.affiliation: Department of Plastic and Reconstructive Surgery, The University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Abe
authors.affiliation: Division of Plastic Surgery, Kochi Health Sciences Center, Kochi, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Harada
authors.affiliation: Department of Plastic and Reconstructive Surgery, Tokushima Red Cross Hospital, Komatsushima, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nagae
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Fujioka
authors.affiliation: Department of Plastic and Reconstructive Surgery, Matsue Red Cross Hospital, Matsue, Japan.
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Anraku
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kawasaki Medical School, Kurashiki, Japan.
authors.forename: Kiichi
authors.initials: K
authors.lastname: Inagawa
authors.affiliation: Department of Plastic and Reconstructive Surgery, The University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakanishi
keywords: Mediastinitis; Omentum; Postoperative complications; Risk factors; Surgical flaps