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. 2022 Jul 12:9:870044.
doi: 10.3389/fsurg.2022.870044. eCollection 2022.

Deep sternal wound infection and pectoralis major muscle flap reconstruction: A single-center 20-year retrospective study

Chen Chen  1 , Yu Gao  2 , Demei Zhao  2 , Zhouji Ma  2 , Yunyan Su  3 , Ran Mo  2
Affiliations

Deep sternal wound infection and pectoralis major muscle flap reconstruction: A single-center 20-year retrospective study

Chen Chen et al. Front Surg. .

Abstract

Background: One of the most drastic complications of median sternal incision is deep sternal wound infection (DSWI), as it can lead to prolonged hospitalization, increased expected costs, re-entry into the ICU and even reoperation. Since the pectoralis major muscle flap (PMMF) technique was proposed in the 1980s, it has been widely used for sternal reconstruction after debridement. Although numerous studies on DSWI have been conducted over the years, the literature on DSWI in Chinese population remains limited. The purpose of this study was to investigate the clinical characteristics of DSWI in patients and the clinical effect of the PMMF at our institution.

Methods: This study retrospectively analyzed all 14,250 consecutive patients who underwent cardiac surgery in the Department of Cardiothoracic Surgery of Drum Tower Hospital from 2001 to 2020. Ultimately, 134 patients were diagnosed with DSWI.,31 of whom had recently undergone radical debridement and transposition of the PMMF in the cardiothoracic surgery or burns and plastic surgery departments because of DSWIs, while the remaining patients had undergone conservative treatment or other methods of dressing debridement.

Results: In total, 9,824 patients were enrolled in the study between 2001 and 2020, of whom 134 met the DSWI criteria and 9690 served as controls. Body mass index (OR = 1.08; P = 0.02; 95% CI, 1.01∼1.16) and repeat sternotomy (OR = 5.93; P < 0.01; 95% CI, 2.88∼12.25) were important risk factors for DSWI. Of the 134 patients with DSWI, 31 underwent the PMMF technique, and the remaining 103 served as controls. There were significant differences in coronary artery bypass grafting (CABG) (P < 0.01), valve replacement (P = 0.04) and repeat sternotomy (P < 0.01) between the case group and the control group. The postoperative extubation time (P < 0.001), ICU time (P < 0.001), total hospitalization time (P < 0.001) and postoperative hospitalization time (P < 0.001) in the PMMF group were significantly lower than those in the control group. The results of multivariate regression analysis showed that PMMF surgery was an important protective factor for the postoperative survival of DSWI patients (OR = 0.12; P = 0.04; 95% CI, 0.01∼0.90).

Conclusions: Staphylococcus aureus was the most common bacteria causing DSWI, which was associated with BMI and reoperation, and can be validly treated with PMMF.

Keywords: DSWI; PMMF; cardiac surgery; flap; infection.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of patient selection algorithm based on inclusion and exclusion criteria. DSWI, deep sternal wound infection. PMMF, pectoralis major muscle flap.
Figure 2
Figure 2
Appearance of deep sternal wound infection before operation.
Figure 3
Figure 3
Surgical procedure and postoperative photos. (A) Infected sternum and implants (blue circle) were removed; (B) The left pectoralis major muscle was exposed; (C) Complete exposure of the pectoralis major muscle (blue circle) and overturning to cover the wound; (D) Suturing through the muscle flap; (F) Immediate appearance after operation; (G) Appearance 2 years after operation.
Figure 4
Figure 4
Comparison of survival rates between the PMMF group and the control group. PMMF, pectoralis major muscle flap. *: P < 0.05.
See this image and copyright information in PMC

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