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An Algorithmic Approach to the Surgical Management of Sternal Dehiscence: A Single-Center Experience. | LitMetric

An Algorithmic Approach to the Surgical Management of Sternal Dehiscence: A Single-Center Experience.

J Reconstr Microsurg

Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

Published: October 2022

AI Article Synopsis

  • Deep sternal wound complications after sternotomy are challenging and are addressed through a combination of surgical techniques such as debridement, flap reconstruction, and rigid sternal fixation (RSF).
  • A review of 134 cardiac patients treated between 2007 and 2019 showed that 83.5% underwent flap closure, with a notable percentage needing multiple debridements before final closure.
  • The study suggests that an aggressive treatment approach can lead to favorable outcomes, and earlier surgical intervention may improve results, especially in low-risk patients.

Article Abstract

Background:  Deep sternal wound complications following sternotomy represent a complex challenge. Management can involve debridement, flap reconstruction, and rigid sternal fixation (RSF). We present our 11-year experience in the surgical treatment of deep sternal wound dehiscence using a standardized treatment algorithm.

Methods:  A retrospective review was conducted of all 134 cardiac patients who required operative debridement after median sternotomy at a single institution between October 2007 and March 2019. Demographics, perioperative covariates, and outcomes were recorded. Univariate and subgroup analyses were performed.

Results:  One-hundred twelve patients (83.5%) with a deep sternal dehiscence underwent flap closure and 56 (50%) RSF. Of the patients who underwent flap closure, 87.5% received pectoralis advancement flaps. A 30-day mortality following reconstruction was 3.9%. Median length of stay after initial debridement was 8 days (interquartile range: 5-15). Of patients with flaps, 54 (48%) required multiple debridements prior to closure, and 30 (27%) underwent reoperation after flap closure. Patients who needed only a single debridement were significantly less likely to have a complication requiring reoperation ( = 10/58 vs. 20/54, 17 vs. 37%,  = 0.02), undergo a second flap ( = 6/58 vs. 17/54, 10 vs. 32%,  < 0.001), or, if plated, require removal of sternal plates ( = 6/34 vs. 11/22, 18 vs. 50%,  = 0.02).

Conclusion:  Although sternal dehiscence remains a complex challenge, an aggressive treatment algorithm, including debridement, flap closure, and consideration of RSF, can achieve good long-term outcomes. In low-risk patients, RSF does not appear to increase the likelihood of reoperation. We hypothesize that earlier surgical intervention, before the development of systemic symptoms, may be associated with improved outcomes.

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Source
http://dx.doi.org/10.1055/s-0042-1743167DOI Listing

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