Flap Reconstruction for Deep Sternal Wound Infections: Factors Influencing Morbidity and Mortality.
Ann Thorac Surg
; 109(5): 1584-1590, 2020 05.
Article
em En
| MEDLINE
| ID: mdl-31982440
ABSTRACT
BACKGROUND:
Deep sternal wound infections (DSWI) often require flap reconstruction to obliterate dead space and provide healthy soft tissue coverage. A better understanding of risk factors for complications after DSWI flap reconstruction may improve operative management.METHODS:
A retrospective study (2007-2018) was conducted of all patients with DSWI after cardiothoracic procedure referred to a single reconstructive surgeon for flap reconstruction. Patient and operative factors were reviewed, including procedure types and outcomes. Predictors of morbidity and mortality rates were analyzed.RESULTS:
A total of 119 patients requiring flap reconstruction for DSWI met inclusion criteria. Unilateral (49.6%) or bilateral (40.3%) pectoralis muscle flaps were performed most frequently, followed by vertical rectus abdominis myocutaneous (VRAM) (4.2%), omental (4.2%), and omental/pectoralis flap combination (1.7%). Superficial surgical site infection (SSI) was the predominant postoperative complication (17.6%). Débridement/revisional procedures were required in 19 patients (16%), and flap failure occurred in 5 (4.2%). Overall 30-day mortality was 15.1%. End-stage renal disease (P = .002), congestive heart failure (P = .049), low albumin (P = .004), cardiopulmonary bypass time (P = .0001), need for open chest (P = .020), and high American Society of Anesthesiologists Physical Status Classification (P = .003) were associated with higher mortality. By multivariate analysis, multidrug resistance was predictive of any postoperative complication (odds ratio [OR], 5.6; 95% confidence interval [CI], 1.3-23.2; P = .018), VRAM was predictive of SSI (OR, 9.6; 95% CI, 1.4-66.4; P = .022), and end-stage renal disease (OR, 8.57; 95% CI, 1.06-69.1; P = .044) was predictive of higher mortality.CONCLUSIONS:
Pectoralis muscle flaps are the workhorse for complex sternal wound coverage, but complications after flap reconstruction for DSWIs remain high. In particular, end-stage renal disease, VRAM reconstruction, and multidrug-resistant infection may predict a complicated postoperative course in these patients.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Músculos Peitorais
/
Esterno
/
Retalhos Cirúrgicos
/
Infecção da Ferida Cirúrgica
/
Procedimentos de Cirurgia Plástica
/
Esternotomia
Tipo de estudo:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article