Deep sternal wound infection following cardiac surgery: A comparison of the monolateral with the bilateral pectoralis major flaps

Torto, Federico Lo; Turriziani, Gianmarco; Casella, Donato; Marcasciano, Marco; Redi, Ugo; Greco, Manfredi; Miraldi, Fabio; Ribuffo, Diego

doi:10.1111/iwj.13324

Cited by 19 publications

(17 citation statements)

References 75 publications

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“…51 In addition, Torto et al also report that DSWI patients who received a combination of NPWT with the monolateral pectoralis major muscle flap have a high coverage effectiveness and guarantee the saving of contralateral muscles with its functionality and the possibility of its use in case of failure. 52 In the present study, long-term antibiotics and adequate drainage with a closed-suction drainage tube were used for the treatment of sternum osteomyelitis and anterior mediastinitis in all patients after wound reconstruction surgery. We observed a lower rate of postoperative complications, re-infection, and mortality.…”

Section: Discussionmentioning

confidence: 97%

“…Recently, an incision management system, Prevena, improves the outcome of DSWI surgical treatment with monolateral pectoralis major muscle flap in a high‐risk patient population 51 . In addition, Torto et al also report that DSWI patients who received a combination of NPWT with the monolateral pectoralis major muscle flap have a high coverage effectiveness and guarantee the saving of contralateral muscles with its functionality and the possibility of its use in case of failure 52 . In the present study, long‐term antibiotics and adequate drainage with a closed‐suction drainage tube were used for the treatment of sternum osteomyelitis and anterior mediastinitis in all patients after wound reconstruction surgery.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of pectoralis muscle flap combined rectus abdominis muscle sheath fasciocutaneous flap for reconstruction of sternal infection

Yao

et al. 2022

International Wound Journal

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Few studies have assessed the efficacy and safety of reconstruction of sternal infection using a pectoralis muscle flap combined with a rectus abdominis muscle (RAM) sheath fasciocutaneous flap. We report here our experience with this procedure to reconstruct the sternal defect in patients (n = 46) with a deep sternal wound infection (DSWI) after cardiac surgery. After wound reconstruction, the proportion of prolonged mechanical ventilation use and intensive care unit (ICU) stay were 17.4% (n = 8) and 21.7% (n = 10), respectively. The 30‐day all‐cause mortality was 15.2%; recurrence rate was 17.4%; postoperative complications were 15.2%; and median hospital stay was 31 (0‐157) days. Multivariate logistic regression analysis revealed that hypertension (β = 21.32, 95%CI 4.955‐37.68, P = .014), drainage‐tube use (β = 0.944, 95%CI 0.273‐1.614, P = .008), and prolonged intensive care unit stay (β = 53.65, 95%CI 31.353‐75.938, P < .001) were significantly correlated with hospital stay. In conclusion, a procedure including surgical debridement, sternal reconstruction with bilateral PM and RAM sheath flap, long‐term antibiotics, and adequate drainage is a beneficial technique in the reconstruction of deep sternal wound infection after cardiac surgery. Duration of drainage tube use may be as an index for a hospital stay or wound healing.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of pectoralis muscle flap combined rectus abdominis muscle sheath fasciocutaneous flap for reconstruction of sternal infection

Yao

et al. 2022

International Wound Journal

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“…To the best of our knowledge, this is the first report depicting the use of an endotracheal tube as haemostatic plug to control major bleeding from large vessels and one of the few reports of aortic rupture as consequence of DSWI. DSWI is a severe complication after cardiac surgery, with a reported incidence ranging from 0.2 to 8.0% 3,4 and early mortality rates from 7.3% to 21.6%. 5,6 Patients with DSWI have significantly higher overall mortality, in-hospital mortality, follow-up mortality, and major adverse cardiovascular events compared with patients without DSWI.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Endotracheal tube as life-saving tool to control an aortic rupture in intensive care unit

Campanella¹,

Abbass²,

Marzi³

et al. 2022

F1000Res

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Background: Aortic rupture and suture dehiscence can complicate a cardiac operation, especially in case of infections of the surgical site. Such a complication can be life-threatening and require immediate surgical treatment. Case: We report the case of a 13-year-old girl who suffered a sudden dehiscence of the aortic suture line in the context of deep sternal wound infection, while in the surgical intensive care unit after a double valve replacement. Control of bleeding was obtained by the insertion of an endotracheal tube into the ascending aorta and inflation of the tube cuff to plug the aortic bleeding point. The extracorporeal circulation was then established and under deep hypothermic arrest the defect was successfully repaired. The patient was discharged 14 days after surgery and reviewed at the outpatient clinic in good health. Conclusions: An endotracheal tube can be used in cases of uncontrollable aortic bleeding as a life-saving tool to bridge the patient to adequate surgical treatment.

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“…The selection of unilateral or bilateral pectoralis major muscle flap is also an important factor affecting the surgical effect and postoperative complications. Compared with bilateral pectoralis major muscle flap, unilateral pectoralis major muscle flap has the benefits of shorter operation time and less invasion, which significantly reduces the incidence of postoperative complications and better preserves the upper limb function and chest contour of patients (13).…”

Section: Discussionmentioning

confidence: 99%

Bilateral partial pectoralis major muscle turnover flaps for the management of deep sternal wound infection following cardiac surgery

Zhang¹,

Lin²,

Yang³

et al. 2020

J Thorac Dis

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The pectoralis major muscle is a versatile flap used as an advancement or turnover flap for the treatment of deep sternal wound infection (DSWI) after median sternotomy. Advancement flaps provide suboptimal mass volume and sometimes cannot fully fill the dead space in the mediastinum. Turnover flaps can sufficiently cover the inferior sternum and fill dead space; however, the procedure requires disinsertion of the muscle from the humerus, resulting in functional loss and cosmetic deformity. In an attempt to optimize the benefits and minimize the drawbacks of both flaps, we developed a novel turnover flap method using the bilateral partial pectoralis major muscle. In this study, we introduce this new flap method and report its initial clinical results. Methods: The bilateral pectoralis major muscle is split into upper and lower parts according to the direction of the muscle fibers. The upper part of the pectoralis major muscle on one side and the lower part of the pectoralis major muscle on the other side were selected as the turnover flaps. The parts of the pectoralis major muscle selected as turnover flaps were transected vertically at the midline of the clavicle.Our novel turnover flap method was used to treat 11 patients with DSWI following cardiac surgery.Results: No deaths occurred in the group. In 10 patients, the chest incision healed without complications and reoperation, while 1 patient experienced delayed healing of the skin incision. None of the patients experienced subcutaneous hematoma or oozing that required reopening and drainage. The average hospitalization time was 14±7.9 days. After 6 months of follow-up, none of the patient had experienced recurrence of DSWI. Abnormal movement of the upper limbs or deformities of the chest wall were not detected in all 11 patients. Conclusions: Bilateral partial pectoralis major muscle turnover flaps are appropriate for the treatment of DSWI after cardiac surgery. This novel method does not only provide sufficient volume to fill the defect but can also preserve the function of the upper limbs and prevent cosmetic deformity of the chest wall.

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Deep sternal wound infection following cardiac surgery: A comparison of the monolateral with the bilateral pectoralis major flaps

Cited by 19 publications

References 75 publications

Efficacy and safety of pectoralis muscle flap combined rectus abdominis muscle sheath fasciocutaneous flap for reconstruction of sternal infection

Efficacy and safety of pectoralis muscle flap combined rectus abdominis muscle sheath fasciocutaneous flap for reconstruction of sternal infection

Case Report: Endotracheal tube as life-saving tool to control an aortic rupture in intensive care unit

Bilateral partial pectoralis major muscle turnover flaps for the management of deep sternal wound infection following cardiac surgery

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