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DOI: 10.1055/s-2007-967654
Management of sternal wound infections using the vacuum-assisted therapy in combination with the pectoralis major and the rectus abdominis myocutaneous flap in heart surgery patients
Introduction: Sternal wound infections are a dreaded complication after median sternotomy and are still a challenging problem for both cardiac and plastic surgeons. In this study, we report our experience using the vacuum-assisted closure therapy (VAC) in combination with the pectoralis major (PEC), rectus abdominis myocutaneous (RAM) and the vertical RAM (VRAM) flap in heart surgery patients with extensive chest wall defects.
Methods: In a retrospective review 3016 consecutive open-heart surgery patients between January 2003 and June 2006 were evaluated: 65.6% underwent coronary artery bypass surgery (CABG), 16.3% cardiac valve replacement, 13.5% combined CABG and valve replacement, 2.8% aortic reconstruction or replacement, 0.6% artificial heart implantation and 1.2% cardiac transplantation.
Results: The incidence of deep sternal wound infections was 2.1% (63 patients). 56 patients underwent irrigation and rewiring, afterwards, 34 patients received a VAC therapy and subsequently, 19 patients were referred to the plastic surgical team. Closure was performed with RAM (4 patients), RAM and unilateral PEC (1), VRAM (7), unilateral PEC (5) and bilateral PEC flap (2). In all patients a sufficient plastic coverage was achieved with no signs of a recurrent sternal infection.
Conclusions: The interdisciplinary joint approach allows safe and efficient treatment of patients who are at high risk for complications such as sternum osteomyelitis. VAC therapy acts as a link between radical debridement and definitive plastic coverage. Several muscle flaps dependent on their anatomical conditions are well established flaps for reconstruction of such deep chest wall defects.