P125. AN ALGORITHMIC APPROACH TO THE SURGICAL MANAGEMENT OF STERNAL DEHISCENCE: A SINGLE CENTER EXPERIENCE

Abstract

PURPOSE: Deep sternal wound complications following sternotomy represents a complex challenge. Management can involve debridement, flap reconstruction, and rigid sternal fixation (RSF). We present our 11-year experience in the surgical treatment of deep sternal wound dehiscence using a standardized treatment algorithm. METHODS: A retrospective review was conducted of all 134 cardiac patients who required operative debridement after sternotomy at a single institution between 10/07-3/19. Demographics, perioperative co-variates, and outcomes were recorded. Univariate and subgroup analysis was performed. RESULTS: One-hundred-twelve patients (83.5%) with a deep sternal dehiscence underwent flap closure and 56 (50%) rigid sternal fixation. Of the patients who underwent flap closure, 87.5% received pectoralis advancement flaps. 30-day mortality following reconstruction was 3.9%. Median length-of-stay after initial debridement was 8 days (IQR5-15). Of patients with flaps, 54 (48%) required multiple debridements prior to closure, and 30 (27%) underwent reoperation after flap closure. Patients who needed only a single debridement were significantly less likely to have a complication requiring reoperation (N= 10/58 vs 20/54, 17% vs 37%, p=0.02), undergo a second flap (N=6/58 vs 17/54, 10% vs 32%, p<0.001) or, if plated, require removal of sternal plates (N=6/58 vs 11/22, 18% vs 50%, p=0.02). CONCLUSION: Although sternal dehiscence remains a complex challenge, an aggressive treatment algorithm, including debridement, flap closure and consideration of RSF, can achieve good long-term outcomes. In appropriately selected patients, RSF does not appear to increase the risk of reoperation. We hypothesize that earlier surgical intervention, before the development of systemic symptoms, may be associated with improved outcomes.