Deep sternal wound infection after open heart surgery--reconstructive options. 2012

Alexander Andersen Juhl, and Vibeke Koudahl, and Tine Engberg Damsgaard
The Department of Plastic Surgery, Aarhus University Hospital, Aarhus, Denmark. alexander@oncology.dk

OBJECTIVE The management of sternal defects arisen after deep sternal wound infection is challenging and often requires extensive interdisciplinary teamwork between plastic and thoracic surgeons. In this study, the published literature on methods used to reconstruct sternal defects arisen as a result of deep sternal wound infection after open-heart surgery will be reviewed. METHODS The Cochrane, Embase, PubMed, and SveMed + databases were searched in December 2011. Only papers regarding treatment of deep sternal wound infection after open-heart surgery in adults were included. RESULTS The literature search identified 224 original papers that met the inclusion criteria. The majority dealt with surgical techniques. None of the studies regarding reconstructive options were designed as randomized controlled trials, and the levels of evidence are generally low. CONCLUSIONS The treatment of deep sternal wound infection has evolved considerably, but there is still little consensus regarding optimal surgical management and a general lack of a standard treatment protocol. The use of muscle flap transposition is well documented. Recent studies recommend the use of topical negative pressure therapy as an adjunct to surgical reconstruction.

UI MeSH Term Description Entries
D006348 Cardiac Surgical Procedures Surgery performed on the heart. Cardiac Surgical Procedure,Heart Surgical Procedure,Heart Surgical Procedures,Procedure, Cardiac Surgical,Procedure, Heart Surgical,Procedures, Cardiac Surgical,Procedures, Heart Surgical,Surgical Procedure, Cardiac,Surgical Procedure, Heart,Surgical Procedures, Cardiac,Surgical Procedures, Heart
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012307 Risk Factors An aspect of personal behavior or lifestyle, environmental exposure, inborn or inherited characteristic, which, based on epidemiological evidence, is known to be associated with a health-related condition considered important to prevent. Health Correlates,Risk Factor Scores,Risk Scores,Social Risk Factors,Population at Risk,Populations at Risk,Correlates, Health,Factor, Risk,Factor, Social Risk,Factors, Social Risk,Risk Factor,Risk Factor Score,Risk Factor, Social,Risk Factors, Social,Risk Score,Score, Risk,Score, Risk Factor,Social Risk Factor
D013249 Sternum A long, narrow, and flat bone commonly known as BREASTBONE occurring in the midsection of the anterior thoracic segment or chest region, which stabilizes the rib cage and serves as the point of origin for several muscles that move the arms, head, and neck.
D013524 Surgical Flaps Tongues of skin and subcutaneous tissue, sometimes including muscle, cut away from the underlying parts but often still attached at one end. They retain their own microvasculature which is also transferred to the new site. They are often used in plastic surgery for filling a defect in a neighboring region. Island Flap,Island Flaps,Flap, Surgical,Flaps, Surgical,Pedicled Flap,Surgical Flap,Flap, Island,Flap, Pedicled,Flaps, Island,Flaps, Pedicled,Pedicled Flaps
D013530 Surgical Wound Infection Infection occurring at the site of a surgical incision. Postoperative Wound Infection,Infection, Postoperative Wound,Infection, Surgical Wound,Surgical Site Infection,Wound Infection, Postoperative,Wound Infection, Surgical,Infection, Surgical Site,Infections, Postoperative Wound,Infections, Surgical Site,Infections, Surgical Wound,Postoperative Wound Infections,Surgical Site Infections,Surgical Wound Infections,Wound Infections, Postoperative,Wound Infections, Surgical
D054843 Negative-Pressure Wound Therapy The application of a vacuum across the surface of a wound through a foam dressing cut to fit the wound. This removes wound exudates, reduces build-up of inflammatory mediators, and increases the flow of nutrients to the wound thus promoting healing. Negative-Pressure Dressings,Topical Negative-Pressure Therapy,Vacuum-Assisted Closure,Closure, Vacuum-Assisted,Closures, Vacuum-Assisted,Dressing, Negative-Pressure,Dressings, Negative-Pressure,Negative Pressure Dressings,Negative Pressure Wound Therapy,Negative-Pressure Dressing,Negative-Pressure Therapies, Topical,Negative-Pressure Therapy, Topical,Negative-Pressure Wound Therapies,Therapies, Negative-Pressure Wound,Therapies, Topical Negative-Pressure,Therapy, Negative-Pressure Wound,Therapy, Topical Negative-Pressure,Topical Negative Pressure Therapy,Topical Negative-Pressure Therapies,Vacuum Assisted Closure,Vacuum-Assisted Closures,Wound Therapies, Negative-Pressure,Wound Therapy, Negative-Pressure
D056346 Sternotomy Making an incision in the STERNUM. Median Sternotomy,Median Sternotomies,Sternotomies,Sternotomies, Median,Sternotomy, Median
D019651 Plastic Surgery Procedures Procedures used to reconstruct, restore, or improve defective, damaged, or missing structures. Cosmetic Reconstructive Surgical Procedures,Cosmetic Surgical Procedures,Esthetic Reconstructive Surgical Procedures,Esthetic Surgical Procedures,Plastic Surgical Procedures,Reconstructive Surgical Procedures,Reconstructive Surgical Procedures, Cosmetic,Cosmetic Reconstructive Surgery,Procedure, Reconstructive Surgical,Procedures, Reconstructive Surgical,Reconstructive Surgical Procedure,Reconstructive Surgical Procedures, Esthetic,Surgical Procedure, Reconstructive,Surgical Procedures, Reconstructive,Cosmetic Reconstructive Surgeries,Cosmetic Surgical Procedure,Esthetic Surgical Procedure,Plastic Surgery Procedure,Plastic Surgical Procedure,Procedure, Cosmetic Surgical,Procedure, Esthetic Surgical,Procedure, Plastic Surgery,Procedure, Plastic Surgical,Procedures, Cosmetic Surgical,Procedures, Esthetic Surgical,Procedures, Plastic Surgery,Procedures, Plastic Surgical,Reconstructive Surgeries, Cosmetic,Reconstructive Surgery, Cosmetic,Surgeries, Cosmetic Reconstructive,Surgery Procedure, Plastic,Surgery Procedures, Plastic,Surgery, Cosmetic Reconstructive,Surgical Procedure, Cosmetic,Surgical Procedure, Esthetic,Surgical Procedure, Plastic,Surgical Procedures, Cosmetic,Surgical Procedures, Esthetic,Surgical Procedures, Plastic

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