LONG-TERM RESULTS OF FLAP RECONSTRUCTION IN MEDIAN STERNOTOMY WOUND INFECTIONS

Reconstruction of infected median sternotomy wounds using muscle and o mental flaps has been shown to result in significantly reduced morbidi ty, mortality, and length of hospital stay. Despite these benefits, ve ry little is known about the potential long-term sequelae of such proc edures. The purpose of this study was therefore to evaluate the ultima te functional outcome in such patients. One-hundred and thirty-three c onsecutive patients underwent debridement and flap reconstruction of t heir infected median sternotomy wounds over an 8-year period. Eighty p atients were available for follow-up and responded to a questionnaire. Forty-eight patients consented to a physical examination. The length of follow-up ranged from 15 to 108 months (average 48 months). Healed wounds were obtained in 99 percent of patients. Fifty-one percent of p atients noted persistent pain or discomfort, particularly in the chest and shoulder. Forty-four percent noted areas of numbness/paresthesias , mainly on the chest. Thirty-four patients (42.5 percent) noted sympt oms of sternal instability; of those consenting to an examination, 45 percent were confirmed to have instability. Twenty-six patients (32.5 percent) claimed postoperative weakness (shoulder/abdomen). Significan t shoulder weakness was not demonstrated; however, abdominal weakness was substantial. Thirty-six percent of patients reported an inability to perform the same preoperative activities that were of importance to them (sports, housework, etc.). Of those patients eligible to return to work, 52 percent did not. Patients younger than age 60 had a somewh at higher chance of not returning to work. Scars were noted to be good to excellent in 15 percent, but contour abnormalities of the chest an d abdomen were found in 85 percent. Abdominal wall pathology (hernias/ bulges) was present in 31 percent of patients, including 10 of 19 pati ents having rectus abdominis flaps, 2 of 3 patients having omental fla ps, and 3 of 41 patients having isolated pectoralis major flaps. Shoul der range of motion was not noticeably affected by operation. Despite the proven advantages of flap reconstruction in mediastinitis, these p rocedures are not without long-term sequelae. Possible methods of prev enting these problems are discussed.