HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wettstein, R. Articles by Banic, A. Search for Related Content PubMed PubMed Citation Articles by Wettstein, R. Articles by Banic, A. Related Collections Chest wall

J Thorac Cardiovasc Surg 2002;123:1185-1190
© 2002 The American Association for Thoracic Surgery

General Thoracic Surgery (GTS)

Radical sternectomy and primary musculocutaneous flap reconstruction to control sternal osteitis

From the Division of Plastic Surgery^a and the Department of Cardiovascular Surgery,^b Inselspital University Hospital, Berne, Switzerland.

Received for publication May 3, 2001. Revisions requested Sept 12, 2001; revisions received Oct 2, 2001. Accepted for publication Oct 24, 2001. Address for reprints: Dominique Erni, MD, Division of Plastic Surgery, Inselspital University Hospital, CH-3010 Berne, Switzerland (E-mail: dominique.erni{at}insel.ch).

Objective: Sternal osteitis after median sternotomy is associated with considerable morbidity and mortality. The use of muscle and omentum flaps has been proved as valid adjunct to combat these severe infections. In this study we present our experience with a more radical approach.
Methods: Sternectomy consisted of the resection of the entire sternum, including the costochondral arches and the sternoclavicular joints, and was followed by the repair of the defect with musculocutaneous flaps without any restabilization of the thoracic wall. Thirteen patients received a vertical rectus abdominis musculocutaneous flap, 14 patients received a pedicled latissimus dorsi musculocutaneous flap, and 12 patients received a free latissimus dorsi musculocutaneous flap (total of 40 flaps in 39 patients of 66 patients who required surgical revision for sternal osteitis of 6078 total patients with sternotomies).
Results: Two patients died within 30 days after the operation (early mortality of 5.1%); however, they did not die of sternal infection, which was cured without any recurrence in all cases. Seventeen patients (44%) required secondary, mostly minor operations for local complications. Despite some paradoxic chest movements, the patient satisfaction rating was unanimously high at the long-term follow-up (0.4 to 8.5 years, median 2.3 years). The short- and long-term complication rates were similar in the three groups.
Conclusion: We conclude that radical sternectomy and immediate musculocutaneous flap repair provided definitive control of sternal infection in even the most severe cases, thus reducing infection-related mortality. The trade-off was a substantial rate of local complications; however, these did not cause any relevant morbidity.

This article has been cited by other articles:

				K. Athanassiadi, N. Theakos, G. Benakis, S. Kakaris, and I. Skottis Omental Transposition: the Final Solution for Major Sternal Wound Infection Asian Cardiovasc Thorac Ann, June 1, 2007; 15(3): 200 - 203. [Abstract] [Full Text] [PDF]

				J. Sjogren, M. Malmsjo, R. Gustafsson, and R. Ingemansson Poststernotomy mediastinitis: a review of conventional surgical treatments, vacuum-assisted closure therapy and presentation of the Lund University Hospital mediastinitis algorithm Eur. J. Cardiothorac. Surg., December 1, 2006; 30(6): 898 - 905. [Abstract] [Full Text] [PDF]

				F. F. Immer, M. Durrer, K. S. Muhlemann, D. Erni, B. Gahl, and T. P. Carrel Deep Sternal Wound Infection After Cardiac Surgery: Modality of Treatment and Outcome Ann. Thorac. Surg., September 1, 2005; 80(3): 957 - 961. [Abstract] [Full Text] [PDF]

				J. Sjogren, R. Gustafsson, J. Nilsson, M. Malmsjo, and R. Ingemansson Clinical Outcome After Poststernotomy Mediastinitis: Vacuum-Assisted Closure Versus Conventional Treatment Ann. Thorac. Surg., June 1, 2005; 79(6): 2049 - 2055. [Abstract] [Full Text] [PDF]

				R. I. Gustafsson, J. Sjogren, and R. Ingemansson Deep sternal wound infection: a sternal-sparing technique with vacuum-assisted closure therapy Ann. Thorac. Surg., December 1, 2003; 76(6): 2048 - 2053. [Abstract] [Full Text] [PDF]

				F. Puma, C. Fedeli, P. Ottavi, G. Porcaro, G. Battista Fonsi, A. Pardini, and G. Daddi Laparoscopic omental flap for the treatment of major sternal wound infection after cardiac surgery J. Thorac. Cardiovasc. Surg., December 1, 2003; 126(6): 1998 - 2002. [Abstract] [Full Text] [PDF]