A reconstructive algorithm for deep sternal wound coverage: the Cologne-Merheim approach

Weinand, Christian; Phan, Truong Quang Vu; Perbix, Walter; Xu, Weiguo; Zinser, Maximilian Jochen; Ehrendorfer, S.; Lefering, Rolf; Spilker, G.

doi:10.1007/s00238-012-0768-1

Cited by 6 publications

(5 citation statements)

References 34 publications

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“…Small wounds up to 6 cm are to be covered by unilateral or bilateral musculocutaneous pectoralis flaps. Unilateral pedicled pectoralis flaps are used for medium wounds (between 7 cm and 12 cm), while in large wounds (>13 cm), a left pedicled latissimus dorsi flap is recommended [Weinand 2013]. Negative pressure wound therapy (NPWT) was introduced as a bridge to surgical closure in patients with persistent deep sternal infections [Weinand 2013;Debreneci 2008;Dickie 2006] in the 1990s.…”

Section: Managementmentioning

confidence: 99%

“…Unilateral pedicled pectoralis flaps are used for medium wounds (between 7 cm and 12 cm), while in large wounds (>13 cm), a left pedicled latissimus dorsi flap is recommended [Weinand 2013]. Negative pressure wound therapy (NPWT) was introduced as a bridge to surgical closure in patients with persistent deep sternal infections [Weinand 2013;Debreneci 2008;Dickie 2006] in the 1990s. It provides continual drainage of bacteria and exudates by negative wound pressure, thus enhancing microcirculation and tissue granulation [Weinand 2013;Debreneci 2008;Dickie 2006].…”

Section: Managementmentioning

confidence: 99%

“…Negative pressure wound therapy (NPWT) was introduced as a bridge to surgical closure in patients with persistent deep sternal infections [Weinand 2013;Debreneci 2008;Dickie 2006] in the 1990s. It provides continual drainage of bacteria and exudates by negative wound pressure, thus enhancing microcirculation and tissue granulation [Weinand 2013;Debreneci 2008;Dickie 2006]. This is usually implemented when primary closure is not feasible, and the sternum is relatively stable.…”

Section: Managementmentioning

confidence: 99%

“…Mechanical dehiscence can be corrected with debridement and approximation of the wound edges. For correction of major complex defects, various techniques have been described, including muscle, musculocutaneous, omentum, and skin flaps and recently the fasciocutaneous flap including the pectoralis major muscle fascia [Sears 2016;Schiraldi 2019;Kubota 2013;Zahiri 2012;Salehi 2007;Weinand 2013].…”

Section: Introductionmentioning

confidence: 99%

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Prevention, Classification and Management Review of Deep Sternal Wound Infection

Al‐Ebrahim

Al-Ebrahim

2020

HSF

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Sternal wound complications are significant problems in cardiac surgery and cause challenges to surgeons as they are associated with high mortality, morbidity, and a tremendous load on the hospital budget. Risk factors and preventive measures against sternal wound infection need to be in focus. Classification of different types of sternotomy complications post cardiac surgery is important for specific categorization and management. Reviewing the literature, a variety of classifications was introduced to help understand the pathophysiology of these wounds and how best to manage them. Initial classifications were based on the postoperative period of the infectious process and risk factors. Recently, the anatomical description of sternal wound, including the depth and location, was shown to be more practical. There is a lack of evidence-based surgical consensus for the appropriate management strategy, including type of closure, choice of sternal coverage post sternectomy, whether primary, delayed and when to use reconstructive flaps.

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Section: Managementmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevention, Classification and Management Review of Deep Sternal Wound Infection

Al‐Ebrahim

Al-Ebrahim

2020

HSF

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“…They recommended pectoralis major muscle flaps for defects in the upper half of the sternum, and combined pectoralis major and rectus abdominis muscle flaps for defects in the lower half and the whole sternum. Another algorithm (the Cologne-Merheim approach) [68] presents a strategy based on wound size and depth, in which small wounds (up to 6 cm) are to be covered by unilateral or bilateral musculocutaneous pectoralis flaps. Unilateral pedicled pectoralis flaps are used for medium wounds (between 7 and 12 cm).…”

Section: Discussionmentioning

confidence: 99%

Deep sternal wound infections: Evidence for prevention, treatment, and reconstructive surgery

et al. 2019

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Median sternotomy is the most popular approach in cardiac surgery. Post-sternotomy wound complications are rare, but the occurrence of a deep sternal wound infection (DSWI) is a catastrophic event associated with higher morbidity and mortality, longer hospital stays, and increased costs. A literature review was performed by searching PubMed from January 1996 to August 2017 according to the guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The following keywords were used in various combinations: DSWI, post-sternotomy complication, and sternal reconstruction. Thirty-nine papers were included in our qualitative analysis, in which each aspect of the DSWI-related care process was analyzed and compared to the actual standard of care. Plastic surgeons are often involved too late in such clinical scenarios, when previous empirical treatments have failed and a definitive reconstruction is needed. The aim of this comprehensive review was to create an up-to-date operative flowchart to prevent and properly treat sternal wound infection complications after median sternotomy.

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Behandlungsregime tiefer sternaler Wundinfektionen nach kardiochirurgischen Eingriffen im interdisziplinären Ansatz

Bieler,

Franke,

Völlmecke

et al. 2023

Unfallchirurgie

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ZusammenfassungZiel dieser Arbeit ist es, anhand der diagnostischen und therapeutischen Herangehensweise bei der interdisziplinären Behandlung von 54 Patienten mit einer tiefen sternalen Wundinfektion (TSWI) nach kardiochirurgischem Eingriff sowie der erzielten Ergebnisse die Wertigkeit eines strukturierten und situationsadaptierten Vorgehens vorzustellen. Es handelte sich um 41 Männer und 13 Frauen mit einem Durchschnittsalter von 65,1 Jahren, die im Zeitraum 2003–2016 nach kardiochirurgischem Eingriff eine TSWI entwickelten. Die Behandlungsstrategie setzte sich zusammen aus dem konsequenten Débridement, einschließlich der Entfernung des einliegenden Fremdmaterials, der Rekonstruktion nach Infektbeherrschung mit stabiler Reosteosynthese und ggf. situationsbedingter Lappenplastik für eine gut durchblutete Defektdeckung und zwingender Vermeidung von Totraum. Es wurden insgesamt 146 Operationen erforderlich (durchschnittlich 2,7 Operationen/Patient, Bereich: eine bis 7 Operationen). In 24,1 % der Fälle konnte ein einzeitiges Vorgehen durchgeführt werden. Bei 41 Patienten wurde zur Wundkonditionierung die „negative pressure wound therapy“ (NPWT) mit programmierten Schwammwechseln angewendet (im Mittel 5 Wechsel, Standardabweichung [SD] ± 5,6 Wechsel über 22 Tage, SD ± 23,9 Tage, Wechselintervall alle 3 bis 4 Tage in 40,7 % der Fälle). Bei 33 Patienten wurde ein beidseitiger myokutaner Pectoralis-major-Lappen genutzt, bei 4 Patienten ein „Vertical-rectus-abdominis-myocutaneous“(VRAM)-Lappen, bei 7 Patienten beide. Am Sternum wurden 43 Osteosynthesen mit winkelstabilen Titanplattensystemen durchgeführt. Sieben Patienten verstarben unter intensivmedizinischer Behandlung (Gesamtmortalität 13 %; n = 5 (9,3 %) ≤ 30 Tage) oder im weiteren Verlauf. Mit saniertem Infekt konnten 47 Patienten entlassen werden (87,1 %). Bei 2 Patienten wurden die Implantate nach 2 Jahren wegen Auslockerung entfernt.

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A reconstructive algorithm for deep sternal wound coverage: the Cologne-Merheim approach

Cited by 6 publications

References 34 publications

Prevention, Classification and Management Review of Deep Sternal Wound Infection

Prevention, Classification and Management Review of Deep Sternal Wound Infection

Deep sternal wound infections: Evidence for prevention, treatment, and reconstructive surgery

Behandlungsregime tiefer sternaler Wundinfektionen nach kardiochirurgischen Eingriffen im interdisziplinären Ansatz

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