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Tex Heart Inst J. 2012;39(3):367-71.

Negative-pressure wound therapy and laparoscopic omentoplasty for deep sternal wound infections after median sternotomy.

Author information

1
Departments of General and Abdominal Surgery, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium. kristof.de.brabandere@gmail.com

Abstract

Deep sternal wound infection remains one of the most serious complications in patients who undergo median sternotomy for coronary artery bypass surgery.We describe our experience in treating 6 consecutive patients with our treatment protocol that combines aggressive d├ębridement, broad-spectrum antibiotics, negative-pressure wound therapy, omentoplasty with laparoscopically harvested omentum, and the use of bilateral pectoral muscle advancement flaps.The number of d├ębridements needed in order to attain clinically clean wounds and negative cultures varied between 1 and 10, with a median of 5. The length of stay after omentoplasty and bilateral pectoral muscle advancement flap placement varied between 11 and 22 days. One of the 6 patients developed a small wound dehiscence that was treated conservatively. No bleeding related to vacuum-assisted closure therapy was identified. Three patients had pneumonia. Two of the 3 patients had an episode of acute renal failure. The 30-day mortality rate was zero, although 1 patient died in the hospital 43 days after the reconstructive surgery, of multiple-organ failure due to pneumonia that was induced by end-stage pulmonary fibrosis. No patient died between hospital discharge and the most recent follow-up date (4-12 mo). Late local follow-up results, both functional and aesthetic, were good.We conclude that negative-pressure wound therapy-in combination with omentoplasty using laparoscopically harvested omentum and with the use of bilateral pectoral advancement flaps-is a valuable technique in the treatment of deep sternal wound infection because it produces good functional and aesthetic results.

KEYWORDS:

Coronary artery bypass grafting; debridement; deep sternal wound infection; laparoscopy; mediastinitis; negative-pressure wound therapy; omentoplasty; surgical flaps; surgical wound infection/mortality/surgery

PMID:
22719146
PMCID:
PMC3368473
[Indexed for MEDLINE]
Free PMC Article

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