Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Immediate Debridement and Reconstruction with a Pectoralis Major Muscle Flap for Poststernotomy Mediastinitis

  • Jang, Yu-Jin (Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine) ;
  • Park, Myong-Chul (Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine) ;
  • Park, Dong-Ha (Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine) ;
  • Lim, Hyo-Seob (Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine) ;
  • Kim, Joo-Hyoung (Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine) ;
  • Lee, Il-Jae (Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine)
  • Received : 2011.09.07
  • Accepted : 2011.12.28
  • Published : 2012.01.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background : Poststernotomy mediastinitis is a rare, but life-threatening complication, thus early diagnosis and proper management is essential for poststernotomy mediastinitis. The main treatment for mediastinitis is aggressive debridement. Several options exist for reconstruction of defects after debridement. The efficacy of immediate debridement and reconstruction with a pectoralis major muscle flap designed for the defect immediately after the diagnosis of poststernotomy mediastinitis is demonstrated. Methods : Between September 2009 and June 2011, 6 patients were referred to the Department of Plastic and Reconstructive Surgery and the Department of Thoracic and Cardiovascular Surgery of Ajou University Hospital for poststernotomy mediastinitis. All of the patients underwent extensive debridement and reconstruction with pectoralis major muscle flaps, advanced based on the pedicle of the thoracoacromial artery as soon as possible following diagnosis. A retrospective review of the 6 cases was performed to evaluate infection control, postoperative morbidity, and mortality. Results : All patients had complete wound closures and reduced severity of infections based on the erythrocyte sedimentation rate and C-reactive protein levels and a reduction in poststernal fluid collection on computed tomography an average of 6 days postoperatively. A lack of growth of organisms in the wound culture was demonstrated after 3 weeks. There were no major wound morbidities, such as hematomas, but one minor complication required a skin graft caused by skin flap necrosis. No patient expired after definitive surgery. Conclusions : Immediate debridement and reconstruction using a pectoralis major muscle flap is a safe technique for managing infections associated with poststernotomy mediastinitis, and is associated with minimal morbidity and mortality.

Keywords

References

  1. Domkowski PW, Smith ML, Gonyon DL Jr, et al. Evaluation of vacuum-assisted closure in the treatment of poststernotomy mediastinitis. J Thorac Cardiovasc Surg 2003;126:386-90. https://doi.org/10.1016/S0022-5223(03)00352-0
  2. Mangram AJ, Horan TC, Pearson ML, et al. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999;20:250-78. https://doi.org/10.1086/501620
  3. Pasaoglu I, Arsan S, Yorgancioglu AC, et al. A simple management of mediastinitis. Int Surg 1995;80:239-41.
  4. Lopez-Monjardin H, de-la-Pena-Salcedo A, Mendoza-Munoz M, et al. Omentum flap versus pectoralis major flap in the treatment of mediastinitis. Plast Reconstr Surg 1998;101:1481-5. https://doi.org/10.1097/00006534-199805000-00008
  5. Jurkiewicz MJ, Bostwick J 3rd, Hester TR, et al. Infected median sternotomy wound: successful treatment by muscle flaps. Ann Surg 1980;191:738-44. https://doi.org/10.1097/00000658-198006000-00012
  6. Morykwas MJ, Argenta LC, Shelton-Brown EI, et al. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 1997;38:553-62. https://doi.org/10.1097/00000637-199706000-00001
  7. Pearl SN, Weiner MA, Dibbell DG. Sternal infection after cardiac transplantation: successful salvage utilizing a variety of techniques. J Thorac Cardiovasc Surg 1982;83:632-4.
  8. Yoo YC, Chung SI, Yang WY, et al. Treatment of acute sternomediastinitis using regional muscleflaps. J Korean Soc Plast Reconstr Surg 2003;30:345-50.
  9. Ascherman JA, Patel SM, Malhotra SM, et al. Management of sternal wounds with bilateral pectoralis major myocutaneous advancement flaps in 114 consecutively treated patients: refinements in technique and outcomes analysis. Plast Reconstr Surg 2004;114:676-83. https://doi.org/10.1097/01.PRS.0000130939.32238.3B
  10. Nahai F, Morales L Jr, Bone DK, et al. Pectoralis major muscle turnover flaps for closure of the infected sternotomy wound with preservation of form and function. Plast Reconstr Surg 1982;70:471-4. https://doi.org/10.1097/00006534-198210000-00010
  11. Ringelman PR, Vander Kolk CA, Cameron D, et al. Longterm results of flap reconstruction in median sternotomy wound infections. Plast Reconstr Surg 1994;93:1208-14. https://doi.org/10.1097/00006534-199405000-00015
  12. Mathes SJ, Eshima I. The principles of muscle and musculocutaneous flaps. In: McCarthy JG, editor. Plastic surgery. 3rd ed. Philadelphia: W. B. Saunders; 1990. p. 379-411.
  13. Greig AV, Geh JL, Khanduja V, et al. Choice of flap for the management of deep sternal wound infection: an anatomical anatomical classification. J Plast Reconstr Aesthet Surg 2007;60:372-8. https://doi.org/10.1016/j.bjps.2006.10.005
  14. Cabbabe EB, Cabbabe SW. Immediate versus delayed onestage sternal debridement and pectoralis muscle flap reconstruction of deep sternal wound infections. Plast Reconstr Surg 2009;123:1490-4. https://doi.org/10.1097/PRS.0b013e3181a205f9

Cited by

  1. Vacuum-assisted closure system in treatment of postoperative mediastinitis vol.21, pp.6, 2012, https://doi.org/10.1177/0218492313479353
  2. Poststernotomy mediastinitis: a classification to initiate and evaluate reconstructive management based on evidence from a structured review vol.9, pp.None, 2012, https://doi.org/10.1186/s13019-014-0179-4
  3. Therapeutic Outcomes of Pectoralis Major Muscle Turnover Flap in Mediastinitis vol.48, pp.4, 2012, https://doi.org/10.5090/kjtcs.2015.48.4.258
  4. Application of Unilateral Pectoralis Major Muscle Flap in the Treatment of Sternal Wound Dehiscence vol.32, pp.5, 2012, https://doi.org/10.21470/1678-9741-2017-0038
  5. Postoperative sternomediastinitis vol.2018, pp.4, 2018, https://doi.org/10.17116/hirurgia2018484-89
  6. Deep sternal wound infection following cardiac surgery: A comparison of the monolateral with the bilateral pectoralis major flaps vol.17, pp.3, 2012, https://doi.org/10.1111/iwj.13324
  7. Impact of microbial findings on plastic reconstructive surgery outcomes in patients with deep sternal wound infection after cardiac surgery vol.54, pp.3, 2012, https://doi.org/10.1080/2000656x.2020.1738240
  8. Prevention, Diagnosis and Management of Post-Surgical Mediastinitis in Adults Consensus Guidelines of the Spanish Society of Cardiovascular Infections (SEICAV), the Spanish Society of Thoracic and Car vol.10, pp.23, 2012, https://doi.org/10.3390/jcm10235566