CLASSIFICATION AND MANAGEMENT OF STERNAL WOUND COMPLICATIONS AFTER CARDIAC SURGERY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHENGShaoyi , CHENHuade , SUNChuanwei , HUANGZhifeng , BIANHuining , LIUZu'an , MALianghua , LIHanhua , DENGYanhua , WANGHuanli ,  LAIWen

Department of Burn and Wound Repair Surgery, Guangdong General Hospital(Guangdong Academy of Medical Sciences), Guangzhou Guangdong, 510080, P. R. China;

Corresponding author：

LAIWen, Email: laiwen@china.com

Keywords：

Cardiac surgery; Sternal wound complication; Classification and management

DOI：

10.7507/1002-1892.20140244

Video：

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Objective To define the classification of sternal wound complications after cardiac surgery and to explore the appropriate surgical treatment. Methods Between July 2008 and January 2014, 260 patients with sternal wound complications after cardiac surgery were treated. There were 124 males and 136 females, aged 11-75 years (mean, 49.5 years). The disease duration was 13-365 days (mean, 26.6 days) with a wound length of 1-25 cm (mean, 13.4 cm). The wounds were divided into type I (n=70), type Ⅱ (n=64), type Ⅲ (n=42), type IV (n=78), and type V (n=6) according to self-generated classification for sternal wound complications after cardiac surgery. After debridement, wounds of type I and type Ⅱ were repaired with local flap transplantation; wounds of type Ⅲ were repaired with local flap transplantation combined with butterfly sternal fixation (n=28), with bilateral pectoralis muscle flap combined with butterfly sternal fixation (n=11), and with bilateral pectoralis muscle flap (n=3); wounds of type IV were repaired with bilateral pectoralis muscle flap (n=65), rectus abdominis muscle flap (n=5), and pedicled omental flap (n=8); and wounds of type V were repaired with pedicled omental flap. Results All the operations were successfully performed. Three patients died after pedicled omental flap repair, including 1 case of type IV and 2 cases of type V. The hospitalization time were 4-86 days (mean, 18.3 days). Primary wound healing was obtained in 248 cases (96.5%); poor healing occurred in 9 patients, which were cured after second surgery in 8 cases and after the third surgery in 1 case. Conclusion The surgical treatment based on self-generated classification is appropriate to sternal wound complications after cardiac surgery. It can provide clinical evidence for the choice of subsequent operation.

Citation： ZHENGShaoyi, CHENHuade, SUNChuanwei, HUANGZhifeng, BIANHuining, LIUZu'an, MALianghua, LIHanhua, DENGYanhua, WANGHuanli, LAIWen. CLASSIFICATION AND MANAGEMENT OF STERNAL WOUND COMPLICATIONS AFTER CARDIAC SURGERY. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(9): 1120-1124. doi: 10.7507/1002-1892.20140244 Copy

1.	Sarr MG, Gott VL, Townsend TR.Mediastinal infection after cardiac surgery.Ann Thorac Surg, 1984, 38(4):415-423.
2.	Rutledge R, Applebaum RE, Kim BJ.Mediastinal infection after open heart surgery.Surgery, 1985, 97(1):88-92.
3.	Loop FD, Lytle BW, Cosgrove DM, et al.J.Maxwell Chamberlain memorial paper.Sternal wound complications after isolated coronary artery bypass grafting:early and late mortality, morbidity, and cost of care.Ann Thorac Surg, 1990, 49(2):179-187.
4.	Gorlitzer M, Wagner F, Pfeiffer S, et al.Prevention of sternal wound complications after sternotomy:results of a large prospective randomized multicentre trial.Interact Cardiovasc Thorac Surg, 2013, 17(3):515-522.
5.	Jones G, Jurkiewicz MJ, Bostwick J, et al.Management of the infected median sternotomy wound with muscle flaps.The Emory 20-year experience.Ann Surg, 1997, 225(6):766-778.
6.	Ivert T, Lindblom D, Sahni J, et al.Management of deep sternal wound infection after cardiac surgery-Hanuman syndrome.Scand J Thorac Cardiovasc Surg, 1991, 25(2):111-117.
7.	匡斌, 陈云瀛, 邓国三, 等.背阔肌肌皮瓣在冠状动脉搭桥术后胸骨切口感染裂开修复中的应用.中华外科杂志, 2005, 43(3):195.
8.	匡斌, 邓国三, 陈云瀛, 等.腹直肌肌皮瓣修复胸前感染裂开的胸骨切口.实用医学杂志, 2006, 22(16):1896-1897.
9.	Fujioka M, Oka K, Kitamura R, et al.Cervical osteomyelitis and epidural abscess treated with a pectoralis major muscle flap.Surg Neurol, 2009, 72(6):761-764.
10.	Milano CA, Georgiade G, Muhlbaier LH, et al.Comparison of omental and pectoralis flaps for poststernotomy mediastinitis.Ann Thorac Surg, 1999, 67(2):377-381.
11.	Pairolero PC, Arnold PG.Management of infected median sternotomy wounds.Ann Thorac Surg, 1986, 42(1):1-2.
12.	El Oakley RM, Wright JE.Postoperative mediastinitis:classification and management.Ann Thorac Surg, 1996, 61(3):1030-1036.
13.	Greig AV, Geh JL, Khanduja V, et al.Choice of flap for the management of deep sternal wound infection-an anatomical classification.J Plast Reconstr Aesthet Surg, 2007, 60(4):372-378.
14.	Karangelis D, Velissaris T, Tsilimingas N.Update on reducing the risks of deep sternal wound complications.Expert Rev Cardiovasc Ther, 2013, 11(5):529-531.
15.	蔡约杰.胸骨正中切口感染危险因素的分析及防治措施.上海:复旦大学, 2011.
16.	Thorsteinsson DT, Valsson F, Geirsson A, et al.Major cardiac rupture following surgical treatment for deep sternal wound infection.Interact Cardiovasc Thorac Surg, 2013, 16(5):708-709.
17.	Taeger CD, Kneser U, Horch RE.Four-flap compound repair of thoracic hernia after sternum osteomyelitis and omentum flap.J Thorac Cardiovasc Surg, 2012, 144(5):e117-119.
18.	赖文, 孙传伟, 李勇, 等.腹腔镜大网膜轴型瓣转移修复乳腺癌术后胸部放射性溃疡.现代医院, 2013, 13(7):30-33.

1. Sarr MG, Gott VL, Townsend TR.Mediastinal infection after cardiac surgery.Ann Thorac Surg, 1984, 38(4):415-423.
2. Rutledge R, Applebaum RE, Kim BJ.Mediastinal infection after open heart surgery.Surgery, 1985, 97(1):88-92.
3. Loop FD, Lytle BW, Cosgrove DM, et al.J.Maxwell Chamberlain memorial paper.Sternal wound complications after isolated coronary artery bypass grafting:early and late mortality, morbidity, and cost of care.Ann Thorac Surg, 1990, 49(2):179-187.
4. Gorlitzer M, Wagner F, Pfeiffer S, et al.Prevention of sternal wound complications after sternotomy:results of a large prospective randomized multicentre trial.Interact Cardiovasc Thorac Surg, 2013, 17(3):515-522.
5. Jones G, Jurkiewicz MJ, Bostwick J, et al.Management of the infected median sternotomy wound with muscle flaps.The Emory 20-year experience.Ann Surg, 1997, 225(6):766-778.
6. Ivert T, Lindblom D, Sahni J, et al.Management of deep sternal wound infection after cardiac surgery-Hanuman syndrome.Scand J Thorac Cardiovasc Surg, 1991, 25(2):111-117.
7. 匡斌, 陈云瀛, 邓国三, 等.背阔肌肌皮瓣在冠状动脉搭桥术后胸骨切口感染裂开修复中的应用.中华外科杂志, 2005, 43(3):195.
8. 匡斌, 邓国三, 陈云瀛, 等.腹直肌肌皮瓣修复胸前感染裂开的胸骨切口.实用医学杂志, 2006, 22(16):1896-1897.
9. Fujioka M, Oka K, Kitamura R, et al.Cervical osteomyelitis and epidural abscess treated with a pectoralis major muscle flap.Surg Neurol, 2009, 72(6):761-764.
10. Milano CA, Georgiade G, Muhlbaier LH, et al.Comparison of omental and pectoralis flaps for poststernotomy mediastinitis.Ann Thorac Surg, 1999, 67(2):377-381.
11. Pairolero PC, Arnold PG.Management of infected median sternotomy wounds.Ann Thorac Surg, 1986, 42(1):1-2.
12. El Oakley RM, Wright JE.Postoperative mediastinitis:classification and management.Ann Thorac Surg, 1996, 61(3):1030-1036.
13. Greig AV, Geh JL, Khanduja V, et al.Choice of flap for the management of deep sternal wound infection-an anatomical classification.J Plast Reconstr Aesthet Surg, 2007, 60(4):372-378.
14. Karangelis D, Velissaris T, Tsilimingas N.Update on reducing the risks of deep sternal wound complications.Expert Rev Cardiovasc Ther, 2013, 11(5):529-531.
15. 蔡约杰.胸骨正中切口感染危险因素的分析及防治措施.上海:复旦大学, 2011.
16. Thorsteinsson DT, Valsson F, Geirsson A, et al.Major cardiac rupture following surgical treatment for deep sternal wound infection.Interact Cardiovasc Thorac Surg, 2013, 16(5):708-709.
17. Taeger CD, Kneser U, Horch RE.Four-flap compound repair of thoracic hernia after sternum osteomyelitis and omentum flap.J Thorac Cardiovasc Surg, 2012, 144(5):e117-119.
18. 赖文, 孙传伟, 李勇, 等.腹腔镜大网膜轴型瓣转移修复乳腺癌术后胸部放射性溃疡.现代医院, 2013, 13(7):30-33.

Chinese Journal of Reparative and Reconstructive Surgery

CLASSIFICATION AND MANAGEMENT OF STERNAL WOUND COMPLICATIONS AFTER CARDIAC SURGERY

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