The Modified Sternoplasty: A Novel Surgical Technique for Treating Mediastinitis

Abstract

Deep sternal wound infection (DSWI), also known as post-sternotomy mediastinitis, is a potentially devastating complication following cardiac surgery, as it is associated with a significant increase in patient morbidity and mortality, prolonged hospitalization, and heavy economic burden. 1-3 DSWI is prevalent in 2% of patients following cardiac surgery and up to 8% in high-risk patients, with mortality rates as high as 40%-47% in the last 50 years 4-6 and significant impacts on patient outcomes. [7][8][9][10][11][12][13][14][15][16][17][18] Current treatment includes negative pressure wound therapy, which can serve both as an adjuvant therapy to treat DSWI as well as bridge these patients to final surgical closure. 19,20 In large and complicated sternal defect cases, surgical approaches may be warranted and include wound reconstruction by muscle flaps, most commonly through bilateral pectoralis muscle as sliding or "turn over" techniques, or by a rectus abdominus muscle or omental flap. [21][22][23][24] We present here the novel modified sternoplasty technique for treating severe DSWI following cardiac surgery, which involves a unique method for sternal reconstruction combined with the use of bilateral pectoralis muscle flaps. METHODSBetween September 2010 and January 2020, 68 patients following cardiac surgery (2.5% of patients, which is similar to levels reported globally) [7][8][9][10][11][12][13][14][15][16][17][18] developed DSWI according to the Center for Disease Control definitions, 25 with wide sternal dehiscence and total exposure of the heart and great vessels. These patients failed to heal with conservative treatment, and therefore underwent the modified sternoplasty surgery.

Predictors of prolonged hospitalization in modified sternoplasty following postoperative mediastinitis

“… 8 , 11 , 14 Therefore, adequate use of hospital resources and limiting LOH is imperative to help reduce patient morbidity and economic burden. We analyzed the results of 68 patients who underwent the Modified Sternoplasty previously described for postoperative mediastinitis, 13 which involves sternal stabilization via a modified Robiscek Technique, followed by bilateral pectoralis muscle major flap advancement.…”

“…The modified sternoplasty technique for deep sternal wound infection has been previously described 13 . This technique began with aggressive irrigation and surgical debridement of the infected tissues and sternum.…”

“…The modified sternoplasty technique for deep sternal wound infection has been previously described. 13 This technique began with aggressive irrigation and surgical debridement of the infected tissues and sternum. If extensive adhesions were present and blunt dissection prevented safe mobilization of the heart from the posterior surface of the sternum, we initiated femoral‐femoral cardiopulmonary bypass to decompress the heart and allow a much safer dissection.…”

“…The modified sternoplasty technique for deep sternal wound infection has been previously described. 13 This technique began with aggressive irrigation and surgical debridement of the infected variables with a statistically significant level of <0.1 were retained in the final model. Subgroup analysis was performed in variable that were significant using an unpaired t-test or a one way analysis of variance to determine the differences between length of hospitalization and clinical variables between the subgroups.…”

“…3,8,11,12 We previously described our experience with the novel Modified Sternoplasty technique for surgically managing DSWI that is complicated by severe sternal dehiscence with exposed heart and great vessels. 13 The aim of this study was to determine predictors for increased length of hospitalization in patients who underwent the Modified Sternoplasty technique for deep sternal wound infection following cardiac surgery to guide further management and care for this patient population.…”