Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Risk Factors for Complications after Reconstructive Surgery for Sternal Wound Infection

  • Hashimoto, Ichiro (Department of Plastic and Reconstructive Surgery, The University of Tokushima Graduate School) ;
  • Takaku, Mitsuru (Department of Plastic and Reconstructive Surgery, The University of Tokushima Graduate School) ;
  • Matsuo, Shinji (Department of Plastic and Reconstructive Surgery, The University of Tokushima Graduate School) ;
  • Abe, Yoshiro (Department of Plastic and Reconstructive Surgery, The University of Tokushima Graduate School) ;
  • Harada, Hiroshi (Division of Plastic Surgery, Kochi Health Sciences Center) ;
  • Nagae, Hiroaki (Department of Plastic and Reconstructive Surgery, Tokushima Red Cross Hospital) ;
  • Fujioka, Yusuke (Department of Plastic and Reconstructive Surgery, Kurashiki Central Hospital) ;
  • Anraku, Kuniaki (Department of Plastic and Reconstructive Surgery, Matsue Red Cross Hospital) ;
  • Inagawa, Kiichi (Department of Plastic and Reconstructive Surgery, Kawasaki Medical School) ;
  • Nakanishi, Hideki (Department of Plastic and Reconstructive Surgery, The University of Tokushima Graduate School)
  • Received : 2013.11.29
  • Accepted : 2014.01.15
  • Published : 2014.05.15
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Abstract

Background Although the utility of flaps for the treatment of sternal wound infections following median sternotomy has been reported for 30 years, there have been few reports on the risk factors for complications after reconstruction. The objective of this investigation was to identify factors related to complications after the reconstruction of sternal wound infections. Methods A retrospective analysis of 74 patients with reconstructive surgery after sternal wound infection over a 5-year period was performed. Clinical data including age, sex, body mass index (BMI), comorbidities, bacterial culture, previous cardiac surgery, wound depth, mortality rate, type of reconstructive procedure, and complication rate were collected. Results The patients' BMI ranged from 15.2 to $33.6kg/m^2$ (mean, $23.1{\pm}3.74kg/m^2$). Wound closure complications after reconstructive surgery were observed in 36.5% of the cases. The mortality rate was 2.7%. Diabetes mellitus significantly affected the rate of wound closure complications (P=0.041). A significant difference in the number of complications was seen between Staphylococcus aureus (S. aureus) and coagulase-negative Staphylococci (P=0.011). There was a correlation between harvesting of the internal thoracic artery and postoperative complications (P=0.048). The complication rates of the pectoralis major flap, rectus abdominis flap, omentum flap, a combination of pectoralis major flap and rectus abdominis flap, and direct closure were 23.3%, 33.3%, 100%, 37.5%, and 35.7%, respectively. Conclusions Diabetes mellitus, S. aureus, harvesting of the internal thoracic artery, and omentum flap were significant factors for complications after reconstruction. The omentum flap volume may be related to the complications associated with the omentum flap transfer in the present study.

Keywords

References

  1. El Oakley RM, Wright JE. Postoperative mediastinitis: classification and management. Ann Thorac Surg 1996;61:1030-6. https://doi.org/10.1016/0003-4975(95)01035-1
  2. Jones G, Jurkiewicz MJ, Bostwick J, et al. Management of the infected median sternotomy wound with muscle flaps. The Emory 20-year experience. Ann Surg 1997;225:766-76. https://doi.org/10.1097/00000658-199706000-00014
  3. Lu JC, Grayson AD, Jha P, et al. Risk factors for sternal wound infection and mid-term survival following coronary artery bypass surgery. Eur J Cardiothorac Surg 2003;23:943-9. https://doi.org/10.1016/S1010-7940(03)00137-4
  4. Morisaki A, Hosono M, Sasaki Y, et al. Evaluation of risk factors for hospital mortality and current treatment for poststernotomy mediastinitis. Gen Thorac Cardiovasc Surg 2011;59:261-7. https://doi.org/10.1007/s11748-010-0727-3
  5. Zahiri HR, Lumpkins K, Kelishadi SS, et al. Significant predictors of complications after sternal wound reconstruction: a 21-year experience. Ann Plast Surg 2012;69:439-41. https://doi.org/10.1097/SAP.0b013e318231d1ef
  6. Kaye AE, Kaye AJ, Pahk B, et al. Sternal wound reconstruction: management in different cardiac populations. Ann Plast Surg 2010;64:658-66.
  7. Furnary AP, Zerr KJ, Grunkemeier GL, et al. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg 1999;67:352-60. https://doi.org/10.1016/S0003-4975(99)00014-4
  8. Loop FD, Lytle BW, Cosgrove DM, et al. J. Maxwell Chamberlain memorial paper. Sternal wound complications after isolated coronary artery bypass grafting: early and late mortality, morbidity, and cost of care. Ann Thorac Surg 1990;49:179-86. https://doi.org/10.1016/0003-4975(90)90136-T
  9. Gardlund B, Bitkover CY, Vaage J. Postoperative mediastinitis in cardiac surgery - microbiology and pathogenesis. Eur J Cardiothorac Surg 2002;21:825-30. https://doi.org/10.1016/S1010-7940(02)00084-2
  10. Baskett RJ, MacDougall CE, Ross DB. Is mediastinitis a preventable complication? A 10-year review. Ann Thorac Surg 1999;67:462-5. https://doi.org/10.1016/S0003-4975(98)01195-3
  11. Lindsey JT. A retrospective analysis of 48 infected sternal wound closures: delayed closure decreases wound complications. Plast Reconstr Surg 2002;109:1882-5. https://doi.org/10.1097/00006534-200205000-00015
  12. Tegnell A, Aren C, Ohman L. Coagulase-negative staphylococci and sternal infections after cardiac operation. Ann Thorac Surg 2000;69:1104-9. https://doi.org/10.1016/S0003-4975(99)01563-5
  13. Ascherman JA, Patel SM, Malhotra SM, et al. Management of sternal wounds with bilateral pectoralis major myocutaneous advancement flaps in 114 consecutively treated patients: refinements in technique and outcomes analysis. Plast Reconstr Surg 2004;114:676-83. https://doi.org/10.1097/01.PRS.0000130939.32238.3B
  14. Li EN, Goldberg NH, Slezak S, et al. Split pectoralis major flaps for mediastinal wound coverage: a 12-year experience. Ann Plast Surg 2004;53:334-7. https://doi.org/10.1097/01.sap.0000120684.64559.49
  15. Spiess AM, Balakrishnan C, Gursel E. Fascial release of the pectoralis major: a technique used in pectoralis major muscle closure of the mediastinum in cases of mediastinitis. Plast Reconstr Surg 2007;119:573-7. https://doi.org/10.1097/01.prs.0000246492.72037.18
  16. Solomon MP, Granick MS. Bipedicle muscle flaps in sternal wound repair. Plast Reconstr Surg 1998;101:356-60. https://doi.org/10.1097/00006534-199802000-00013
  17. Greig AV, Geh JL, Khanduja V, et al. Choice of flap for the management of deep sternal wound infection: an anatomical classification. J Plast Reconstr Aesthet Surg 2007;60:372-8. https://doi.org/10.1016/j.bjps.2006.10.005
  18. Davison SP, Clemens MW, Armstrong D, et al. Sternotomy wounds: rectus flap versus modified pectoral reconstruction. Plast Reconstr Surg 2007;120:92934.
  19. Krabatsch T, Fleck E, Hetzer R. Treating poststernotomy mediastinitis by transposition of the greater omentum: late angiographic findings. J Card Surg 1995;10:46-51. https://doi.org/10.1111/j.1540-8191.1995.tb00589.x
  20. Lopez-Monjardin H, de-la-Pena-Salcedo A, Mendoza-Munoz M, et al. Omentum flap versus pectoralis major flap in the treatment of mediastinitis. Plast Reconstr Surg 1998;101:1481-5. https://doi.org/10.1097/00006534-199805000-00008
  21. Atkins BZ, Onaitis MW, Hutcheson KA, et al. Does method of sternal repair influence long-term outcome of postoperative mediastinitis? Am J Surg 2011;202:565-7. https://doi.org/10.1016/j.amjsurg.2011.06.013
  22. Arner P, Andersson DP, Thorne A, et al. Variations in the size of the major omentum are primarily determined by fat cell number. J Clin Endocrinol Metab 2013;98:E897-901. https://doi.org/10.1210/jc.2012-4106
  23. Stump A, Bedri M, Goldberg NH, et al. Omental transposition flap for sternal wound reconstruction in diabetic patients. Ann Plast Surg 2010;65:206-10. https://doi.org/10.1097/SAP.0b013e3181c9c31a
  24. Kobayashi T, Mikamo A, Kurazumi H, et al. Secondary omental and pectoralis major double flap reconstruction following aggressive sternectomy for deep sternal wound infections after cardiac surgery. J Cardiothorac Surg 2011;6:56. https://doi.org/10.1186/1749-8090-6-56
  25. Izaddoost S, Withers EH. Sternal reconstruction with omental and pectoralis flaps: a review of 415 consecutive cases. Ann Plast Surg 2012;69:296-300. https://doi.org/10.1097/SAP.0b013e31822af843

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