title: A simple protocol for the management of deep sternal surgical site infection: a retrospective study of twenty-five cases.
abstract: BACKGROUND
  Deep sternal incisional surgical site infection is a serious and potentially life-threatening complication after open heart surgery. Although a rare post-operative complication, the rates of post-operative morbidity and mortality are greater in patients who develop a deep sternal incisional surgical site infection than in those who do not.
  
  
  METHODS
  We evaluated retrospectively the results of patients who developed a deep sternal incisional surgical site infection who were treated with either a pectoralis major flap or delayed primary closure after previous negative-pressure wound therapy (NWPT). From July 2007 to July 2012, 25 patients had a deep sternal incisional surgical site infection after open heart surgery in the Departments of Plastic Surgery and Cardiac Surgery of the Tri-Service General Hospital Medical Center. Sternal refixation was not performed in our patients.
  
  
  RESULTS
  In 15 patients, a unilateral or bilateral pectoralis major advancement flap with a myocutaneous or muscle flap was used. In seven patients, delayed primary closure was performed after NPWT. One patient received a rectus abdominis myocutaneous flap and another received a free anterior lateral thigh flap. One patient died after developing nosocomial pneumonia with severe sepsis after debridement.
  
  
  CONCLUSIONS
  In our series, no patient required sternal re-fixation. Our findings suggest that delayed primary closure and use of a unilateral or bilateral pectoralis major flap following NPWT for a deep sternal incisional surgical site infection are simple and quick methods for managing such difficult surgical incisions even if the deep sternal surgical site infection is located in the lower one-third of the sternum.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital , National Defense Medical Center, Taipei, Taiwan, Republic of China .
authors.forename: Yu-Jen
authors.initials: YJ
authors.lastname: Shih
authors.forename: Shun-Cheng
authors.initials: SC
authors.lastname: Chang
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Wang
authors.forename: Niann-Tzyy
authors.initials: NT
authors.lastname: Dai
authors.forename: Shyi-Gen
authors.initials: SG
authors.lastname: Chen
authors.forename: Tim-Mo
authors.initials: TM
authors.lastname: Chen
authors.forename: Yuan-Sheng
authors.initials: YS
authors.lastname: Tzeng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013249:Sternum / Q000473:pathology*; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome