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

Abstract

The pedicled latissimus flap has to be considered as the preferred method in large sternal wounds to achieve sufficient defect filling. The risk of wound healing disruption is significantly influenced by bacteria detected in the sternal wound at the point of reconstructive surgery.

Management of Sternal Wound Infection—Determinants of Length of Stay and Recurrence of Infection after Muscle Flap Coverage

“…Pech et al analyzed the treatment of 130 patients treated by latissimus flap to cover sternal wounds between 2009 and 2015 retrospectively. 7 The reoperation rate because of wound healing problems was 21.5% and bleeding complications leading to reoperation occurred in 10.8% of all patients. In this setting, high dose therapy with danaparoid/fondaparinux was a significant risk factor for bleeding complications…”

“…Treatment ranges from antibiotics and a single-stage operation, debridement of all necrotic tissues with removal of all foreign materials and exposed cartilage in subtotal sternotomy and muscle flap coverage, as also noted in the current S3 guidelines on the management of mediastinitis after cardiac surgery. [4][5][6][7] After radical infection repair by subtotal sternotomy and defect coverage by a muscle flap, some patients develop a new wound healing disorder, which often leads to reoperation and prolonged hospitalization. 8,9 Treatment of these patients is time-consuming and recurrence of infection cannot be excluded in any case.…”