The Conundrums of Defect Management in Deep Sternal Wound Infection: Review

Abstract

Deep Sternal Wound Infection (DWSI) remains an important cause of morbidity and mortality following Cardiac surgery. Equally many methods of preventing it from occurring have been stated however when it does occur, the management by debridement and provision of cover for the defect can be challenging and thus different treatment options are instituted with various degrees of success. The use of Vacuum Assisted Closure therapy was stated as been mere effective in treatment of DSWI with mechanism not known but better used as an adjunct to flaps and with a potential for profuse bleeding. The major advantage in the use of Pectoralis Major Flap was in its bulky size that allows for the cover of defect following sternectomy. However, it had a serious draw back in neonates and infants as the compressive effect on the heart and the distortion of the mammary line and its preclusion in patients with previous radionecrosis and the divergent opinions for further resternontomy. The omental flap has the advantage of provision of cover as may be occasioned by deep defect; in extensive sepsis because of the immunogenic functions and does not lead to deformity but serious complications as the herniation of the transverse colon as an important drawback to its use.This present review gives the omental flap a slight superior edge over the other two when considering the cover for defect; taking care of local sepsis and resternotomy. However, what is needed now is a multicenter randomised study to determine the option that best suit this condition.