• Eleftherios Spartalis, Charalampos Markakis, Demetrios Moris, Elias Lachanas, E Andreas Agathos, Anna Karakatsani, Grigorios Karagkiouzis, Antonios Athanasiou, Dimitrios Dimitroulis, and Periklis Tomos.
• 2nd Department of Propedeutic Surgery, University of Athens, Medical School, Athens General Hospital "Laikon", Agiou Thoma 17, 11527, Athens, Greece.
• Surg. Today. 2016 Apr 1; 46 (4): 460-5.

PurposePost-sternotomy deep sternal wound infection (DSWI) is a severe complication of cardiac surgery. The introduction of omental and muscle flaps has resulted in a significant decrease in morbidity and mortality. In this article, we present the findings for a series of 55 consecutive patients with DSWI treated using an alternative bi-pectoral musculofascial flap technique.MethodsThe patients were stratified into two groups (one-or two-stage intervention). Patients with septic wounds initially underwent debridement and wound treatment, while vacuum therapy was used in a subset of the subjects. All patients were treated with wound debridement and bi-pectoral advancement flap reconstruction.Results30-day mortality was 5.4%. Most patients (72%) were treated in two stages, while vacuum therapy was used in 20% of the patients. The mean number of hospitalization days was 8 and 12 for the one- and the two-stage groups, respectively. Reconstruction was successful in all but three patients, each of whom developed recurrent infection. No major morbidity was reported at a mean follow-up of 82 months with excellent functional and aesthetic outcomes.ConclusionsPectoralis-major muscle flaps remain relevant in the modern management of post-sternotomy mediastinitis. The addition of an omental flap should be considered in cases in which the lower sternum is involved. Prompt diagnosis and a meticulous surgical technique ensure favorable results for the majority of patients.

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