title: Sternal reconstruction of deep sternal wound infections following median sternotomy by single-stage muscle flaps transposition.
abstract: OBJECTIVE
  To assess clinical effectiveness of using bilateral pectoralis major or plus rectus abdominis muscle flaps in treating deep sternal wound infection (DSWI) following median sternotomy.
  
  
  METHODS
  Between January 2009 and December 2013, 19 patients with DSWI after median sternotomy for cardiac surgery were admitted to our hospital, including 14 males (73.7%) and 5 females (26.3%), aged 55±13 (18-78) years. According to the Pairolero classification of infected median sternotomies, 3 (15.8%) patients were type II, and the other 16 (84.2%) were type III. Surgical procedure consisted of adequate debridement of infected sternum, costal cartilage, granulation, steel wires, suture residues and other foreign substances. Sternal reconstruction used the bilateral pectoralis major or plus rectus abdominis muscle flaps to obliterate dead space. The drainage tubes were placed and connected to a negative pressure generator for adequate drainage.
  
  
  RESULTS
  There were no intraoperative deaths. In 15 patients (78.9%), bilateral pectoral muscle flaps were mobilized sufficiently to cover and stabilize the defect created by wound debridement. 4 patients (21.0%) needed bilateral pectoral muscle flaps plus rectus abdominis muscle flaps because their pectoralis major muscle flaps could not reach the lowest portion of the wound. 2 patients (10.5%) presented with subcutaneous infection, and 3 patients (15.8%) had hematoma. They recovered following local debridement and medication. 17 patients (89.5%) were examined at follow-up 12 months later, all healed and having stable sternum. No patients showed infection recurrence during the follow-up period over 12 months.
  
  
  CONCLUSIONS
  DSWI following median sternotomy may be effectively managed with adequate debridement of infected tissues and reconstruction with bilateral pectoralis major muscle or plus rectus abdominis muscle flap transposition.
authors.affiliation: Department of Cardiac Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Song
authors.initials: S
authors.lastname: Wu
authors.affiliation: Department of Cardiac Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Wan
authors.affiliation: Department of Cardiac Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Yong-shun
authors.initials: YS
authors.lastname: Gao
authors.affiliation: Department of Cardiac Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Cardiac Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Zhao
authors.affiliation: Department of Cardiac Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Zhong-qi
authors.initials: ZQ
authors.lastname: Cui
authors.affiliation: Department of Cardiac Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Ji-yan
authors.initials: JY
authors.lastname: Xie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013249:Sternum / Q000293:injuries*; D013524:Surgical Flaps; D014947:Wounds and Injuries / Q000601:surgery*; D055815:Young Adult