Management Of Deep Sternal Infection Research Articles

Evaluating the effectiveness of using negative pressure wound therapy in the preservation of the infected prosthetic aortic graft

BackgroundInfected deep sternal infection due to an associated infection of the prosthetic aortic graft is a devastating condition. Standard management requires the removal of the graft and substituting it with a new one. Often, removal of the prosthetic graft is close to impossible. Negative pressure wound therapy is currently the treatment of choice for patients with deep sternal infection. However, its use in deep sternal infection with exposed infected prosthetic aortic graft has not been well described. MethodsEight patients were included in this study. All had type A aortic dissection of the ascending aorta and/or aortic arch. ResultsThere were 7 men and 1 woman. The median age was 53 years old (range 33–81 years old). The median number of days from the initial aortic operation to the diagnosis of infection was 20 days (range 14–52). The median length of stay in the intensive care unit was 17 days (range 6–338 days). The median time interval from the initial debridement to reconstruction was 20 days (range 6–43 days). The median number of times negative pressure wound therapy was changed was 4 (range 2–9). The most common flap used for reconstruction was the pectoralis major musculocutaneous flap in 7 patients, a free antero-lateral thigh flap in 1 patient, and pedicled omental flap in combination with pectoralis major musculocutaneous flap in 1 patient. One patient had persistent recurrent infection of the graft despite negative pressure wound therapy and flap reconstruction. The median length of follow-up was 38.5 months (range 4–120 months). ConclusionThis small study suggests that negative pressure wound therapy could be used successfully for the management of deep sternal infection due to infected prosthetic aortic grafts. In most cases, it eliminated the need to replace the infected prosthetic aortic graft in high-risk patients.

Management of deep sternal infection in infants and children with advanced pectoralis major muscle flaps

Background Advanced pectoralis major muscle flaps can be used to treat deep sternal wound infections in children; however, the long-term outcomes have not been widely reported. Methods We retrospectively reviewed 11 patients (median age, 3.8 months), who had developed deep sternal wound infections following median sternotomy, among 1380 consecutive pediatric cardiac procedures from January 1995 to July 2001. Results Advanced pectoralis major muscle flaps were used in 10 patients bilaterally and in 1 patient unilaterally. All survived and were discharged without evidence of infection. During a mean ± standard deviation follow-up of 42.1 ± 20.9 months, there was no evidence of recurrent or chronic infection. All patients demonstrated normal development with no limitations to their upper trunk or limb movements. All of the 6 patients who had undergone a palliative operation initially had additional operations without difficulty through the existing sternotomy incision. Conclusions This technique proved to be easy and promoted wound healing that covered all of the sternal wound defects without tension and without requiring additional flaps. It produced minimal growth and developmental problems, and it might facilitate additional operations.