The Impact of Preoperative Negative-Pressure Wound Therapy on Pectoralis Major Muscle Flap Reconstruction for Deep Sternal Wound Infections. Issue 2 (August 2019)

• Record Type: Journal Article
• Authors: Barbera, Federico; Lorenzetti, Fulvio; Marsili, Ricccardo; Lisa, Andrea; Guido, Gabriele; Pantaloni, Marcello
• Is Part Of: Annals of plastic surgery. Volume 83:Issue 2(2019)
• Publication Date: 2019-08
• Subjects: deep sternal wound infection -- muscle flap -- negative-pressure wound therapy -- pectoralis major muscle flap -- sternal reconstruction; Surgery, Plastic -- Periodicals; 617.95205
• DOI: 10.1097/SAP.0000000000001799
• Languages: English
• ISSNs: 0148-7043

Abstract

Abstract : Background: Deep sternal wound infection (DSWI) represents a life-threatening complication following open-heart surgery and pectoralis major muscle flap reconstruction has led to a significant reduction in mortality and morbidity. Negative-pressure wound therapy represented a step forward in DSWI treatment, both as a single procedure or as a preparation for reconstructive surgery. In the present study, we report our 13 years' experience with sternal reconstruction in order to evaluate the impact of preoperative vacuum-assisted closure (VAC) therapy on reconstructive outcome. Methods: Seventy-three patients diagnosed with DSWI undergoing pectoralis major muscle flap reconstruction were divided into 2 subgroups: preoperative VAC treatment group (n = 37) and no preoperative VAC (NVAC n = 36). We collected patients' DSWI and reconstructive surgery clinical data, and we analyzed surgical outcome in terms of complication rate, reoperation rate, defects closure times, and intraoperative/30-day and 1-year mortality. Results: Eighty-three flaps were used, bilateral flaps were used more in the NVAC subgroup ( P = 0.005), and operative time was significantly shorter in the VAC subgroup ( P < 0.001). Complication rate was 9.6%, with no significant differences between the 2 subgroups ( P = 0.723). There was no recurrence of mediastinitis, and all flaps survived. Sternal closure time was significantly lower in the VAC subgroup ( P < 0.001). No intraoperative death occurred; 30-day and 1-year mortality were 2.7% and 19.2%, respectively, with no significant difference between the 2 groups ( P = 0.596). Conclusions: Preoperative VAC therapy makes reconstructive surgery easier and faster, even though it has no impact on complication rate and overall success of the reconstruction. Pectoralis major muscle flap represents a reliable solution even if not associated with preoperative VAC.