Abstract
Deep sternal wound infection is a feared complication of open-heart surgery. Negative pressure wound therapy has gained an important role in the treatment of deep sternal wound infection. Incisional negative pressure wound therapy has been introduced as a method to prevent wound complications after sternotomy, and lately, after flap reconstructions in the treatment of deep sternal wound infection. We aimed to study if incisional negative pressure wound therapy with PICO™ had similar beneficial effect described earlier with competing commercial devices. This study included 82 patients treated with pectoralis major muscle flap for deep sternal wound infection during the years 2006-2020. PICO group consisted of 24 patients treated with preoperative negative pressure wound therapy and postoperative incisional negative pressure wound therapy (PICO™). Two control groups included 48 patients with conventional treatment and 10 patients with preoperative negative pressure wound therapy only. In the PICO group, the complication rate declined from 50.0% to 33.30%, major complication rate from 29.2% to 12.5%, and need for an additional flap from 14.6.% to 4.2% when compared to conventional treatment. The length of hospital stay decreased as well. Preoperative negative pressure wound therapy alone was associated with moderate decline in the complication rates. In addition, we described the use of split pectoralis major muscle flap reconstruction in 57 patients. To our knowledge, this is the largest published patient series describing this method in the treatment of deep sternal wound infection. Incisional negative pressure wound therapy with PICO™ seems beneficial after flap reconstruction. Split pectoralis major muscle flap is a versatile reconstruction option suitable to be used as a workhorse in the treatment of deep sternal wound infection.
Highlights
Deep sternal wound infection (DSWI) is a rare but devastating complication of open-heart surgery
All remaining 82 patients with the pectoralis major muscle flap were included and divided into three groups as follows: PICO group consisted of 24 patients treated with preoperative negative pressure wound therapy (NPWT), pectoralis major muscle flap reconstruction, and postoperative incisional negative pressure wound therapy (iNPWT) between the years 2012 and 2020; control group 1 consisted of 48 patients treated between 2006 and 2012 with pectoralis major muscle flap without any forms of NPWT; and control group 2 consisted of 10 patients treated between 2012 and 2017 with preoperative NPWT and pectoralis major muscle flap (Fig. 1)
There were 87 patients treated with the pectoralis major muscle flap for DSWI in the Kuopio University Hospital between the years 2006 and 2020
Summary
Deep sternal wound infection (DSWI) is a rare but devastating complication of open-heart surgery. Incisional negative pressure wound therapy has been introduced as a method to prevent wound complications after sternotomy, and lately, after flap reconstructions in the treatment of deep sternal wound infection. Methods: This study included 82 patients treated with pectoralis major muscle flap for deep sternal wound infection during the years 2006–2020. We described the use of split pectoralis major muscle flap reconstruction in 57 patients. To our knowledge, this is the largest published patient series describing this method in the treatment of deep sternal wound infection. Split pectoralis major muscle flap is a versatile reconstruction option suitable to be used as a workhorse in the treatment of deep sternal wound infection
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