Chapter 95 - Muscle flap coverage of sternal wound infections

Summary

The median sternotomy was first described by Julian in 1957 for use in cardiac surgery. A 5% sternal wound infection rate was reported, and the treatment of choice was debridement and open packing. Since that time, management of sternal wounds has changed drastically. Shumacker and Mandelbaum introduced the closed-chest catheter irrigation system in 1963 and reduced mortality from 50 to 20%. The pedicled omental flap was advocated by Lee et al. in 1976. A few years later, Jurkiewicz et al. revolutionized the treatment algorithm with the introduction of muscle flaps.

Sternal wound infections are divided into superficial (affecting the skin, subcutaneous tissue, and pectoralis fascia only) and deep. It is important to recognize patient risk factors (including, but not limited to): BMI > 30 kg/m², diabetes mellitus, urgent operation, sepsis/endocarditis after surgery, smoking history within one year, COPD, renal insufficiency, and history of stroke. The most commonly isolated pathogen is coagulase-negative staphylococcus, followed by Staphylococcus aureus, Propioni, Acinetobacter, Enterobacter cloacae, Escherichia coli, and Klebsiella. There is a subset of patients who never grow bacteria; they are deemed to have non-infectious sternal dehiscence.