Infraareolar pectoralis major myocutaneous island flap as treatment of first choice for deep sternal wound infection

Repeated chest wall reconstruction after resection of a sternal chondroid chordoma with long-term postoperative infection of the reconstructive material

We present the case of a 23-year-old man with a chondroid chordoma of the sternum. The patient underwent chest wall resection, followed by stabilization using a sandwich graft of Prolene mesh and methylmethacrylate, covered with bilateral pedicled musculus pectoralis flaps. After adjuvant radiotherapy and 2 years of follow-up, the patient developed a graft-associated infection. We removed the allogeneic material and the encapsulated abscess, and the wound was conditioned through negative wound pressure therapy. This time, wound closure and chest wall stabilization were achieved with a Prolene mesh covered by a free anterolateral thigh flap. This case demonstrates the importance of carefully considering the material for chest wall stabilization and establishing multidisciplinary cooperation.

Titanium plate fixation versus conventional approach in the treatment of deep sternal wound infection

Background

Deep sternal wound infection (DSWI) is a serious complication post cardiac surgery and associated with increased mortality, morbidity and cost. Sternal titanium plate fixation could be an effective approach to treat DSWI. We sought to compare the effectiveness of titanium plate fixation with conventional approach in the treatment of DSWI.

Methods

Retrospective data was analyzed from consecutive patients with DSWI post cardiac surgery who received either titanium plate fixation (sternal plate group) or conventional treatment with sternal debridement and rewiring (control group). Pre-operative risk factors and post-operative clinical outcome were compared between the 2 groups.

Results

A total of 36 patients (mean age 65.0 ± 8.6, 63.9 % male) with DSWI were in the sternal plate group whereas 26 patients (mean age 64.0 ± 13.4, 65.4 % male) were in the control group. The mean follow-up period was 15.92 months. The major pre-operative comorbidities were comparable between the 2 groups. The rate of receiving multiple debridement procedures (≥3) was significantly lower in the sternal plate group (5.6 % vs. 26.9 %, P = 0.03). Patients in the sternal plate group had no treatment failure, whereas 42.3 % of patients in the control group had treatment failure requiring muscle flaps reconstruction by plastic surgery (0 % vs. 42.3 %, P < 0.001). There was a trend of lower in-hospital mortality (11.1 % vs. 19.2 %, P = 0.47) in the sternal plate group.

Conclusion

Compared to conventional treatment, titanium plate fixation appears to have favorable clinical outcome.