Our experience using the vertical rectus abdominis muscle flap for reconstruction in 12 patients with dehiscence of a median sternotomy wound and mediastinitis

Clarkson, James H. W.; Probst, Fey; Niranjan, Niri S.; Meuli, Claudia; Vogt, Paul; Lidman, Disa; Andersson, Lena C.

doi:10.1080/02844310310000455

Cited by 12 publications

(4 citation statements)

References 14 publications

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“…However, median sternotomy is associated with a variety of complications, of which the most life-threatening condition is mediastinitis [ 2 ]. Mediastinitis, or deep sternal wound infection (DSWI), has been reported to occur in 0.4%–8.4% of patients after median sternotomy, although the most frequently reported incidence is 1%–3% [ 3 , 4 ]. DSWI is a potentially fatal condition due to subsequent septicemia and sepsis, with a reported mortality rate of 5%–50%, and is also associated with higher morbidity, leading to longer hospitalization and placing a heavy economic burden on the healthcare system [ 5 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Outcomes of Pectoralis Major Muscle Turnover Flap in Mediastinitis

Bagheri

Tashnizi

Haghi

et al. 2015

Korean J Thorac Cardiovasc Surg

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BackgroundThis study aimed to evaluate the therapeutic results and safety of pectoralis major muscle turnover flaps in the treatment of mediastinitis after coronary artery bypass grafting (CABG) procedures.MethodsData regarding 33 patients with post-CABG deep sternal wound infections (DSWIs) who underwent pectoralis major muscle turnover flap procedures in the Emam Reza and Ghaem Hospitals of Mashhad, Iran were reviewed in this study. For each patient, age, sex, hospital stay duration, remission, recurrence, and associated morbidity and mortality were evaluated.ResultsOf the 2,447 CABG procedures that were carried out during the time period encompassed by our study, DSWIs occurred in 61 patients (2.5%). Of these 61 patients, 33 patients (nine females [27.3%] and 24 males [72.7%]) with an average age of 63±4.54 years underwent pectoralis major muscle turnover flap placement. Symptoms of infection mainly occurred within the first 10 days after surgery (mean, 10.24±13.62 days). The most common risk factor for DSWIs was obesity (n=16, 48.4%) followed by diabetes mellitus (n=13, 39.4%). Bilateral and unilateral pectoralis major muscle turnover flaps were performed in 20 patients (60.6%) and 13 patients (39.4%), respectively. Complete remission was achieved in 25 patients (75.7%), with no recurrence in the follow-up period. Four patients (12.1%) needed reoperation. The mean hospitalization time was 11.69±6.516 days. Four patients (12.1%) died during the course of the study: three due to the postoperative complication of respiratory failure and one due to pulmonary thromboembolism.ConclusionPectoralis major muscle turnover flaps are an optimal technique in the treatment of post-CABG mediastinitis. In addition to leading to favorable therapeutic results, this flap is associated with minimal morbidity and mortality, as well as a short hospitalization time.

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Section: Introductionmentioning

confidence: 99%

Therapeutic Outcomes of Pectoralis Major Muscle Turnover Flap in Mediastinitis

Bagheri

Tashnizi

Haghi

et al. 2015

Korean J Thorac Cardiovasc Surg

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“…To cover an extensive defect involving both upper and lower sternums, bilateral PM flap is often recommended. 7,10,14 In addition to bilateral PM flaps, rectus abdominis flap, 7,16,17 omentum flap, 18,19 the combined rectus abdominis and omentum flap with or without PM flap, and free flaps were also described in the literature for sternal wound defect reconstruction. Hallock reported a series of 22 patients using combined PM and rectus abdominis muscle flaps for both upper and lower sternal defect reconstructions, where rectus abdominis flap was raised specifically to cover xiphisternum.…”

Section: Discussionmentioning

confidence: 99%

Unilateral Pedicled Pectoralis Major Harvested by Endoscopic-Assisted Method Achieves Adequate Management of Sternal Infection and Mediastinitis

Lin

Tsai

et al. 2019

J reconstr Microsurg

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Background Bilateral PM muscles or combination with rectus abdominis or omentum are commonly used for upper and lower sternal wound infections. Unilateral PM harvesting using endoscopic-assisted method may have a simple, safe, and reliable entire muscle harvesting with comparable result of less donor-site violation. Methods A retrospective review was performed from 2003 till 2015 on 38 patients referred to a single plastic surgeon for treatment of sternal wound infection following median sternotomy for cardiovascular surgery. After the humerus insertion of PM was cut with the assistance of endoscope visualization, all the other PM insertions on the sternum, rib, and clavicle were divided, the unilateral pedicled PM can be advanced approximately 10 cm to cover the cephalad and caudal sternum, and fill the retrosternal mediastinum. Results Four re-explorations in three patients for postoperative hematoma occurred. No early recurrent infection for wound dehiscence experienced. Three patients died of multiple organs failures as 30-day mortality. Two patients underwent late recurrent infections; one patient had twice wire infection removals at 4 and 6 months after transfer, and the other had another PM for rib osteomyelitis in 3 years. Conclusion Unilateral PM transfer is justified to provide a simple, reliable, straightforward procedure for sternal infection management and mediastinal obliteration without violation of second flap in compromised patients.

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“…Deep sternal wound infection (DSWI) is a rare but potentially devastating complication of median sternotomy performed in cardiac surgery. The incidence of this complication ranges between 1 and 3% [ 1 , 2 ] and on average mortality of 10–47% [ 3 , 4 ]. It is difficult to treat when compared to skin and subcutaneous tissue infections.…”

Section: Introductionmentioning

confidence: 99%

Antibiotic-loaded bone cement combined with vacuum sealing drainage to treat deep sternal wound infection following cardiac surgery: the first case report

Jiang

et al. 2021

J Cardiothorac Surg

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Background Deep sternal wound infection (DSWI) is a rare but serious complication after median sternotomy, and treatment success depends mainly on surgical experience. Here we first present a case of a patient successfully treated for antibiotic-loaded bone cement (ALBC) combined with vacuum sealing drainage (VSD) of DSWI. Case presentation This case report presented a patient who underwent open heart surgery, and suffered postoperatively from a DSWI associated with enterococcus cloacae. Focus debridement combined with ALBC filling and VSD was conducted in stage I. Appropriate antibiotics were started according to sensitivity to be continued for 2 weeks until the inflammatory markers decreased to normal. One month after the surgery, patient’s wound was almost healed and was discharged from hospital with a drainage tube. Two months after the stage I surgery procedure, the major step was removing the previous ALBC, and extensive debridement in stage II. The patient fully recovered without further surgical treatment. Conclusions The results of this case suggest that ALBC combined with VSD may be a viable and safe option for deep sternal wound reconstruction.

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Our experience using the vertical rectus abdominis muscle flap for reconstruction in 12 patients with dehiscence of a median sternotomy wound and mediastinitis

Cited by 12 publications

References 14 publications

Therapeutic Outcomes of Pectoralis Major Muscle Turnover Flap in Mediastinitis

Therapeutic Outcomes of Pectoralis Major Muscle Turnover Flap in Mediastinitis

Unilateral Pedicled Pectoralis Major Harvested by Endoscopic-Assisted Method Achieves Adequate Management of Sternal Infection and Mediastinitis

Antibiotic-loaded bone cement combined with vacuum sealing drainage to treat deep sternal wound infection following cardiac surgery: the first case report

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