Abstract
Background Deep sternal wound complications following sternotomy represent 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 median sternotomy at a single institution between October 2007 and
March 2019. Demographics, perioperative covariates, and outcomes were recorded. Univariate
and subgroup analyses were performed.
Results One-hundred twelve patients (83.5%) with a deep sternal dehiscence underwent flap
closure and 56 (50%) RSF. Of the patients who underwent flap closure, 87.5% received
pectoralis advancement flaps. A 30-day mortality following reconstruction was 3.9%.
Median length of stay after initial debridement was 8 days (interquartile range: 5–15).
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 = 6/34 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 low-risk patients, RSF does not appear to increase the
likelihood of reoperation. We hypothesize that earlier surgical intervention, before
the development of systemic symptoms, may be associated with improved outcomes.
Keywords
deep sternal wound infection - pectoralis flap - rigid sternal fixation
