Sternal reconstruction after post-sternotomy mediastinitis

Journal of Cardiothoracic Surgery
Pankaj Kaul

Abstract

Deep sternal wound complications are uncommon after cardiac surgery. They comprise sternal dehiscence, deep sternal wound infections and mediastinitis, which will be treated as varying expressions of a singular pathology for reasons explained in the text. This article reviews the definition, prevalence, risk factors, prevention, diagnosis, microbiology and management of deep sternal wound infections and mediastinitis after cardiac surgery. The role of negative pressure wound therapy and initial and delayed surgical management is discussed with special emphasis on plastic techniques with muscle and omental flaps. Recent advances in reconstructive surgery are presented. Deep sternal wound complications no longer spell debilitating morbidity and high mortality. Better understanding of risk factors that predispose to deep sternal wound complications and general improvement in theatre protocols for asepsis have dramatically reduced the incidence of deep sternal wound complications. Negative pressure wound therapy and appropriately timed and staged muscle or omental flap reconstruction have transformed the outcomes once these complications occur.

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Citations

Aug 1, 2019·Interactive Cardiovascular and Thoracic Surgery·Jeremy TricardFrançois Bertin
Jul 2, 2020·Revista brasileira de enfermagem·Mayra de Castro OliveiraVanessa de Brito Poveda
Aug 29, 2020·International Wound Journal·Zhi WangXiao-Jun Wang
Jun 12, 2019·Journal of Cardiothoracic Surgery·Petre V H Botianu
May 23, 2020·Plastic and Reconstructive Surgery. Global Open·Hidetaka WatanabeHiroshige Kawano
Oct 17, 2020·Indian Journal of Thoracic and Cardiovascular Surgery : Official Organ, Association of Thoracic and Cardiovascular Surgeons of India·Andrea Dell'AmoreDomenica Giunta
Jun 17, 2021·Journal of Cardiac Surgery·John S Ikonomidis
Jun 29, 2021·Seminars in Diagnostic Pathology·Julie Lin, Carlos A Jimenez
Jul 27, 2021·Scandinavian Cardiovascular Journal : SCJ·Heidi-Mari MyllykangasJari Halonen
Aug 21, 2021·Plastic and Reconstructive Surgery. Global Open·Allen F YiStephen J Poteet
Sep 7, 2021·Scandinavian Journal of Surgery : SJS : Official Organ for the Finnish Surgical Society and the Scandinavian Surgical Society·Heidi-Mari MyllykangasLeena T Berg
Jan 1, 2022·The Thoracic and Cardiovascular Surgeon·Zihni M DumanTimuçin Aksu

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Methods Mentioned

BETA
PCR
dissection

Software Mentioned

Acarturk

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