Reconstructive Management of Deep Sternal Wound Infections: A Review and Surgical Algorithm

Correspondence: Nihir Gupta (E-mail: [e-mail])

Abstract

Introduction This study provides a critical analysis of the evolution and current practices of sternal wound reconstruction in the management of deep sternal wound infection (DSWI), with an emphasis on enhancing clinical outcomes and surgical efficacy.

Background Preventive measures, such as prophylactic antibiotic administration and meticulous surgical site preparation, are essential in reducing the incidence of deep sternal wound infection (DSWI). Historically, treatment relied on closed irrigation and drainage techniques, which, while offering certain benefits, demonstrated variable outcomes and notable limitations. Contemporary care paradigms now emphasize a multidisciplinary approach involving surgical debridement, prophylactic antibiotics, and surgical interventions including vacuum-assisted closure (VAC), skin grafting, and flap-based reconstruction.

Methodology This study retrospectively analyzed patients who underwent cardiac surgery in the Department of Cardiothoracic Surgery at our tertiary care center. Ultimately, around 1% patients were diagnosed with DSWI, 25% of whom had recently undergone debridement, hardware removal, and proper tissue cultures, followed by appropriate management with skin graft or flap closure in the plastic surgery department, while the remaining patients had undergone conservative treatment or other methods of dressing debridement.

Results The results of our analysis showed that in most cases, PMMF provide excellent coverage while eliminating dead space and providing sternal compression. Secondary flap options and skin grafting were also occasionally used. This study provides an overview and simplified approach to sternal wound reconstruction.

Conclusion Deep sternal wound infection (DSWI) is a serious complication of cardiothoracic surgery, influenced by patient and surgical factors. Early identification of risk factors and prompt diagnosis via assessment and imaging are key. Timely management—debridement, drainage, and reconstruction—helps prevent further issues. Plastic surgery offers benefits like better healing and aesthetics, but requires expertise and carries risks. Reconstruction should be individualized based on patient-specific factors.

Keywords: DSWI, debridement, VAC, PMMF flap, algorithmic reconstruction

Publikationsverlauf

Artikel online veröffentlicht:
10. November 2025