@article{3124505,
    title = "Results of the modified bi-pectoral muscle flap procedure for post-sternotomy deep wound infection",
    author = "Spartalis, E. and Markakis, C. and Moris, D. and Lachanas, E. and Agathos, E.A. and Karakatsani, A. and Karagkiouzis, G. and Athanasiou, A. and Dimitroulis, D. and Tomos, P.",
    journal = "Cataract & Refractive Surgery Today",
    year = "2016",
    volume = "46",
    number = "4",
    pages = "460-465",
    publisher = "Springer Tokyo",
    doi = "10.1007/s00595-015-1192-5",
    keywords = "adult;  aged;  Article;  bi pectoral muscle flap;  debridement;  disease severity;  esthetics;  female;  heart surgery;  human;  length of stay;  major clinical study;  male;  mediastinitis;  muscle flap;  pectoralis major muscle;  recurrent infection;  sternotomy;  sternum;  surgical infection;  surgical mortality;  surgical technique;  treatment outcome;  vacuum assisted closure;  vacuum assisted closure device;  adverse effects;  follow up;  mediastinitis;  pectoral muscle;  procedures;  reconstructive surgery;  severity of illness index;  sternotomy;  surgical flaps;  Surgical Wound Infection, Debridement;  Female;  Follow-Up Studies;  Humans;  Length of Stay;  Male;  Mediastinitis;  Pectoralis Muscles;  Reconstructive Surgical Procedures;  Severity of Illness Index;  Sternotomy;  Surgical Flaps;  Surgical Wound Infection;  Treatment Outcome",
    abstract = "Purpose: Post-sternotomy deep sternal wound infection (DSWI) is a severe complication of cardiac surgery. The introduction of omental and muscle flaps has resulted in a significant decrease in morbidity and mortality. In this article, we present the findings for a series of 55 consecutive patients with DSWI treated using an alternative bi-pectoral musculofascial flap technique. Methods: The patients were stratified into two groups (one-or two-stage intervention). Patients with septic wounds initially underwent debridement and wound treatment, while vacuum therapy was used in a subset of the subjects. All patients were treated with wound debridement and bi-pectoral advancement flap reconstruction. Results: 30-day mortality was 5.4 %. Most patients (72 %) were treated in two stages, while vacuum therapy was used in 20 % of the patients. The mean number of hospitalization days was 8 and 12 for the one- and the two-stage groups, respectively. Reconstruction was successful in all but three patients, each of whom developed recurrent infection. No major morbidity was reported at a mean follow-up of 82 months with excellent functional and aesthetic outcomes. Conclusions: Pectoralis-major muscle flaps remain relevant in the modern management of post-sternotomy mediastinitis. The addition of an omental flap should be considered in cases in which the lower sternum is involved. Prompt diagnosis and a meticulous surgical technique ensure favorable results for the majority of patients. © 2015, Springer Japan."
}