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Reconstruction for sternotomy wound complications after cardiac surgery: a 10-year experience

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Sternotomy wound complications are potentially serious sequelae of cardiac surgery and can be associated with significant morbidity. We aimed to examine our experiences over the past 10 years, in particular the reconstruction of sternal wounds.

Methods

Data from 2009 to 2019 in a single tertiary centre was analysed using our prospective cardiac surgery database. We examined risk factors and management of sternal wound infection/dehiscence, including reconstruction and complications.

Results

Thirty-five (0.5%) patients had sternal wound complications that required flap reconstruction. Chronic obstructive pulmonary disease (p < 0.001), diabetes (p = 0.02), and lower preoperative haemoglobin (p = 0.001) were significantly associated with requiring reconstruction. In patients undergoing reconstruction, the median age was 69.0 years and 33/35 survived to discharge. Cardiac surgeons performed three reconstructive procedure (bilateral pectoralis major advancements) and two of these required further reconstruction by plastic surgeons at a later date. Bilateral pectoralis major advancement was the most common reconstructive procedure. Twenty percent of patients (7) developed a haematoma or seroma post reconstruction and 3 (9%) developed a hernia, which use of fasciocutaneous flaps appeared to be a risk factor for.

Conclusions

In our trust, practice has evolved so that plastic surgeons are now always involved in soft tissue coverage of sternal wound defects. We aim to obtain adequate soft tissue coverage at the first reconstructive operation to avoid requiring further procedures. Bilateral pectoralis major advancement remains an essential foundation for soft tissue coverage of the sternum. However, caution is advised with using local flaps including fascia due to high rates of hernia demonstrated.

Level of evidence: Level IV, risk/prognostic; therapeutic study.

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Data availability

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Code availability

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Acknowledgements

We gratefully acknowledge Neil Richards for providing the cardiac surgery database.

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Authors and Affiliations

  1. Department of Plastic Surgery, Hull University Teaching Hospitals NHS Trust, Castle Road, Cottingham, HU16 5JQ, UK

    Claire Madeline Hardie, Ammar Allouni, Nikita Nighoskar & Paolo Luciano Matteucci

  2. Department of Cardiothoracic Surgery, Hull University Teaching Hospitals NHS Trust, Castle Road, Cottingham, HU16 5JQ, UK

    Mahmoud Loubani

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  1. Claire Madeline Hardie
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  2. Ammar Allouni
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  3. Nikita Nighoskar
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  4. Mahmoud Loubani
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  5. Paolo Luciano Matteucci
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Contributions

All authors contributed to the study conception and design. Data collection was performed by Claire Madeline Hardie, Ammar Allouni and Nikita Nighoskar. Data analysis was performed by Claire Madeline Hardie. Supervision was performed by Mahmoud Loubani and Paolo Luciano Matteucci. The first draft of the manuscript was written by Claire Madeline Hardie and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Claire Madeline Hardie.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Relevant ethical approvals were obtained from our institution Clinical Audit and Governance Committee.

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Patients signed informed consent regarding publishing their data and photographs.

Informed consent

Informed consent was obtained from individuals included in the study.

Conflict of interest

Claire Madeline Hardie, Ammar Allouni, Nikita Nighoskar, Mahmoud Loubani and Paolo Luciano Matteucci declare no conflict of interest.

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Hardie, C.M., Allouni, A., Nighoskar, N. et al. Reconstruction for sternotomy wound complications after cardiac surgery: a 10-year experience. Eur J Plast Surg 45, 257–265 (2022). https://doi.org/10.1007/s00238-021-01828-y

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  • DOI: https://doi.org/10.1007/s00238-021-01828-y

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