title: Results of the modified bi-pectoral muscle flap procedure for post-sternotomy deep wound infection.
abstract: OBJECTIVE
  Post-sternotomy deep sternal wound infection (DSWI) is a severe complication of cardiac surgery. The introduction of omental and muscle flaps has resulted in a significant decrease in morbidity and mortality. In this article, we present the findings for a series of 55 consecutive patients with DSWI treated using an alternative bi-pectoral musculofascial flap technique.
  
  
  METHODS
  The patients were stratified into two groups (one-or two-stage intervention). Patients with septic wounds initially underwent debridement and wound treatment, while vacuum therapy was used in a subset of the subjects. All patients were treated with wound debridement and bi-pectoral advancement flap reconstruction.
  
  
  RESULTS
  30-day mortality was 5.4%. Most patients (72%) were treated in two stages, while vacuum therapy was used in 20% of the patients. The mean number of hospitalization days was 8 and 12 for the one- and the two-stage groups, respectively. Reconstruction was successful in all but three patients, each of whom developed recurrent infection. No major morbidity was reported at a mean follow-up of 82 months with excellent functional and aesthetic outcomes.
  
  
  CONCLUSIONS
  Pectoralis-major muscle flaps remain relevant in the modern management of post-sternotomy mediastinitis. The addition of an omental flap should be considered in cases in which the lower sternum is involved. Prompt diagnosis and a meticulous surgical technique ensure favorable results for the majority of patients.
authors.affiliation: 2nd Department of Propedeutic Surgery, University of Athens, Medical School, Athens General Hospital "Laikon", Agiou Thoma 17, 11527, Athens, Greece.
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Spartalis
authors.affiliation: 2nd Department of Propedeutic Surgery, University of Athens, Medical School, Athens General Hospital "Laikon", Agiou Thoma 17, 11527, Athens, Greece.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Markakis
authors.affiliation: 2nd Department of Propedeutic Surgery, University of Athens, Medical School, Athens General Hospital "Laikon", Agiou Thoma 17, 11527, Athens, Greece. dimmoris@yahoo.com.|, Anastasiou Gennadiou 56, 11474, Athens, Greece. dimmoris@yahoo.com.
authors.forename: Demetrios
authors.initials: D
authors.lastname: Moris
authors.affiliation: 2nd Department of Propedeutic Surgery, University of Athens, Medical School, Athens General Hospital "Laikon", Agiou Thoma 17, 11527, Athens, Greece.
authors.forename: Elias
authors.initials: E
authors.lastname: Lachanas
authors.affiliation: 2nd Department of Propedeutic Surgery, University of Athens, Medical School, Athens General Hospital "Laikon", Agiou Thoma 17, 11527, Athens, Greece.
authors.forename: E Andreas
authors.initials: EA
authors.lastname: Agathos
authors.affiliation: 2nd Department of Propedeutic Surgery, University of Athens, Medical School, Athens General Hospital "Laikon", Agiou Thoma 17, 11527, Athens, Greece.
authors.forename: Anna
authors.initials: A
authors.lastname: Karakatsani
authors.affiliation: 2nd Department of Propedeutic Surgery, University of Athens, Medical School, Athens General Hospital "Laikon", Agiou Thoma 17, 11527, Athens, Greece.
authors.forename: Grigorios
authors.initials: G
authors.lastname: Karagkiouzis
authors.affiliation: 2nd Department of Propedeutic Surgery, University of Athens, Medical School, Athens General Hospital "Laikon", Agiou Thoma 17, 11527, Athens, Greece.
authors.forename: Antonios
authors.initials: A
authors.lastname: Athanasiou
authors.affiliation: 2nd Department of Propedeutic Surgery, University of Athens, Medical School, Athens General Hospital "Laikon", Agiou Thoma 17, 11527, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Dimitroulis
authors.affiliation: 2nd Department of Propedeutic Surgery, University of Athens, Medical School, Athens General Hospital "Laikon", Agiou Thoma 17, 11527, Athens, Greece.
authors.forename: Periklis
authors.initials: P
authors.lastname: Tomos
mesh_terms: D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008480:Mediastinitis / Q000209:etiology / Q000601:surgery*; D010369:Pectoralis Muscles; D019651:Plastic Surgery Procedures / Q000379:methods*; D012720:Severity of Illness Index; D056346:Sternotomy / Q000009:adverse effects*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Bi-pectoral flap; Post-sternotomy mediastinitis; Sternotomy