Muscle flap reconstruction for the treatment of major sternal wound infections after cardiac surgery: A 10-year analysis

Infection of a median sternotomy wound is a rare though potentially fatal c omplication. Despite early diagnosis and proper treatment, prognosis is poo r because of the chance of mediastinal spread of the infection and the poor physical state of these patients. Muscle repair is superior to more conser vative surgical options such as sternal resuturing with mediastinal irrigat ion. During the last 10 years, complications-including sternal infections a nd dehiscences-have been encountered in 172/4725 median sternotomy wounds a fter cardiac surgery procedures (4%). Thirty-four patients (of whom 30 had acute sternal infections and four chronical sternal infections) underwent a ggressive sternal debridement followed by muscle flap closure. Seventy-two muscle flaps were carried out, a pectoralis major bilateral muscle flap bei ng the most common either alone or in combination with a rectus abdominis m uscle flap. Five perioperative deaths (15%) were recorded. Of the 29 surviv ing patients, 25 patients (74%) were free of infection and four (12%) devel oped recurrence of the infection after a mean follow up of 3 years (range 4 9 days-8 years). We conclude that although muscle repair is not foe of comp lications, it is reliable in reducing mediastinitis-related morbidity and m ortality.