Failure of Secondary Wound Closure After Sternal Wound Infection Following Failed Initial Operative Treatment

Abstract

Female patients after CABG, with large sternal wounds infected with gram-negative bacteria and candida, have an 85% risk of wound dehiscence after flap coverage for sternal wound infection.

Determining risk factors for surgical wound dehiscence: a literature review

“…Tekumit et al compared two different internal fixation techniques used in cardiothoracic surgery and reported that the rates of dehiscence are similar between the two methods. Wound dehiscence may be attributed to SSI as discussed by Graf et al and Phan et al who both reported that microbial presence as a contributing factor to wound dehiscence. One could suggest that less than optimal surgical closure and infection when combined could be doubly problematic.…”

“…Timely and sustained postoperative wound healing plays a significant role in optimising a patient's postoperative recovery and rehabilitation. It has been established that surgical wound dehiscence (SWD) contributes to increased morbidity and mortality rates, and implicit and explicit costs for individuals and health care providers (1)(2)(3)(4)(5). Explicit costs result from prolonged hospitalisation, the need for community nursing and support services and the use of wound management consumables (6)(7)(8)(9)(10).…”

“…A review of the literature for factors associated with SWD was conducted in response to an identified increase in SWD referrals to a community nursing service in Western Australia, following either a cardiothoracic, orthopaedic, vascular or abdominal surgical procedure. The aim of this review was to • postoperative risk factors include hypoxemia or prolonged ventilation, length of ICU stay, blood transfusion and hypotension • in conclusion, this review provides a broad description on documented risk factors associated with SWD following a procedure in the following area: abdominal, cardiothoracic, orthopaedic and vascular surgery Wound dehiscence is a possible complication following any surgical procedure; however, most authors (1)(2)(3)9,10,(12)(13)(14) report the occurrence following orthopaedic, abdominal, cardiothoracic and vascular surgery. The literature outlines some associations between SWD and patient comorbidities and the type of surgical wound closure (5,6,12,(15)(16)(17)(18)(19).…”

Therapie der Sternumosteomyelitis nach medianer Sternotomie bei 130 Patienten mittels gestielter myokutaner Latissimuslappenplastik

“…Der M. latissimus dorsi wird aufgrund der verlässlichen Gefäßanatomie und -versorgung als gestielte und freie Lappenplastik seit vielen Jahren im Rahmen vielfältiger plastischer Rekonstruktionen eingesetzt [14,15] Individuelle Patientendaten und perioperative Parameter, die sich in anderen Studien bereits als die Wundheilung beeinflussend herausgestellt haben, wurden registriert, um diese auf einen statistischen Zusammenhang in Hinblick auf Vorkommen der 2 Zielvariablen "revisionspflichtige Wundheilungsstörung" und "revisionspflichtige Nachblutung" hin zu untersuchen. Hierzu zählen allgemeine Patientencharakteristika (Geschlecht, Alter, BMI), Vorerkrankungen (Diabetes mellitus, COPD, Niereninsuffizienz), das Keimspektrum bei Defektdeckung sowie perioperative Parameter (OP-Zeit, Art der perioperativen Antikoagulation) [6,14,[16][17][18][19]. Die Zielvariable "revisionspflichtige Wundheilungsstörung" wurde allgemein formuliert, es handelte sich hierbei um Wundrandnekrosen (z. T. mit partiellem Lappenverlust), die nicht mit konservativer Wundbehandlung therapierbar waren und daher operative Revisionen erforderlich machten.…”

Selected Methods of the Chest Wall Reconstruction for Sternal Dehiscence after Median Sternotomy

“…This method together with pectoralis flap coverage decreases the risk of developing sternal dehiscence and therefore is recommended in cases with a history of chest irradiation (1,5). Depending on the localization, extensiveness, and profoundness of the defect a variety of muscle flaps may be used to cover the frontal mediastinum, in particular: pectoralis major, rectus abdominis (VRAM, TRAM) or latissimus dorsi (LD) (11)(12)(13)(14). There are several ways to use them for the individual situations, sometimes in modified fashions, as bipedicle advancement pectoralis flap together with thoracoacromial perforators ("tripedicle") or with greater omental transposition (15,16).…”