A rational approach to wound difficulties after sternotomy: Reconstructionand long-term results

One hundred fifty-one patients were reconstructed after median sternotomy b y a single plastic surgeon over a 6-year period. The treatment included imm ediate reconstruction (63 patients) and delayed reconstructions (88 patient s). Ninety eight percent of the patients had definitive healing at 6 weeks with an overall 30-day mortality of 4 percent. The issues of long-term intr avenous antibiotics, perceived skin deficiency, cardiac decompensation, Can dida infections, and reexploration of a healed mediastinum after flap recon struction are discussed. Follow up (4 months to 6 years) of patients treate d with reconstruction compared favorably with patients treated with rewirin g procedures (20 patients) in regard to strength, chest wall stability, pul monary function testing, and functional return to hobbies and employment. ( C) 2001 by The Society of Thoracic Surgeons.