Objective To investigate surgical treatment of sternal and substernal infection after cardiac and major vascular surgery.
Methods Between January 2008 and December 2012, 118 patients with secondary sternal and substernal infection following cardiac and major vascular surgery underwent pectoralis major muscle flap transposition in our department. Clinical data on these patients were retrospectively analysed. The operative procedure was as follows: first endotracheal anaesthesia was performed; the pectoralis major muscle flap was then transposed to the sternal defect area after a thorough debridement, and a drain with the suction device of negative pressure was placed, with primary suture of the operative wound.
Results Of 118 patients 115 were cured and 117 had a surviving muscle flap, of which one was converted to a rectus abdominis muscle flap transposition owing to pectoralis major muscle flap necrosis. Operative wounds of 98 patients showed primary healing (83%). Hospital discharge of eight patients was postponed for one week due to subcutaneous wound infection. Subcutaneous wound infection occurred again in seven patients one week after leaving hospital, with wounds healed after dressing. Five patients were unhealed due to residue of sequestrum and costal chondritis and were cured after undergoing debridement and pectoralis major muscle flap transposition again. Of the three patients who died, one died of septicemia and bacterial endocarditis, one died from renal failure, and the last patient died one week after self-discharge from hospital due to postoperative wound re-infection after mediastinal infection. The average postoperative hospital stay was 14 ± 10 days. The longest postoperative follow-up period was 40 months, and no patients were re-infected.
Conclusions Surgical debridement and reconstruction of the sternal defect with pectoralis major muscle flap is one of the best Methods:for treating sternal and substernal infection after cardiac and major vascular surgery, and is an effective measure to improve patient survival rate and quality of life.