Long-term results of flap reconstruction in median sternotomy wound infections

Paul R. Ringelman, Craig Vander Kolk, Duke Cameron, William A Baumgartner, Paul Manson

Research output: Contribution to journalArticle

Abstract

Reconstruction of infected median sternotomy wounds using muscle and omental flaps has been shown to result in significantly reduced morbidity, mortality, and length of hospital stay. Despite these benefits, very little is known about the potential long-term sequelae of such procedures. The purpose of this study was therefore to evaluate the ultimate functional outcome in such patients. One-hundred and thirty-three consecutive patients underwent debridement and flap reconstruction of their infected median sternotomy wounds over an 8-year period. Eighty patients were available for follow-up and responded to a questionnaire. Forty-eight patients consented to a physical examination. The length of follow-up ranged from 15 to 108 months (average 48 months). Healed wounds were obtained in 99 percent of patients. Fifty-one percent of patients noted persistent pain or discomfort, particularly in the chest and shoulder. Fortyfour percent noted areas of numbness/paresthesias, mainly on the chest. Thirty-four patients (42.5 percent) noted symptoms of sternal instability; of those consenting to an examination, 45 percent were confirmed to have instability. Twenty-six patients (32.5 percent) claimed postoperative weakness (shoulder/abdomen). Significant shoulder weakness was not demonstrated; however, abdominal weakness was substantial. Thirty-six percent of patients reported an inability to perform the same preoperative activities that were of importance to them (sports, housework, etc.). Of those patients eligible to return to work, 52 percent did not. Patients younger than age 60 had a somewhat higher chance of not returning to work. Scars were noted to be good to excellent in 75 percent, but contour abnormalities of the chest and abdomen were found in 85 percent. Abdominal-wall pathology (hernias/bulges) was present in 31 percent of patients, including 10 of 19 patients having rectus abdominis flaps, 2 of 3 patients having omental flaps, and 3 of 41 patients having isolated pectoralis major flaps. Shoulder range of motion was not noticeably affected by operation. Despite the proven advantages of flap reconstruction in mediastinitis, these procedures are not without long-term sequelae. Possible methods of preventing these problems are discussed.

Original languageEnglish (US)
Pages (from-to)1208-1214
Number of pages7
JournalPlastic and Reconstructive Surgery
Volume93
Issue number6
StatePublished - 1994

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Sternotomy
Wound Infection
Thorax
Abdomen
Length of Stay
Wounds and Injuries
Mediastinitis
Housekeeping
Rectus Abdominis
Return to Work
Hypesthesia
Paresthesia
Abdominal Wall
Debridement
Hernia
Articular Range of Motion
Physical Examination
Cicatrix
Sports

ASJC Scopus subject areas

  • Surgery

Cite this

Long-term results of flap reconstruction in median sternotomy wound infections. / Ringelman, Paul R.; Vander Kolk, Craig; Cameron, Duke; Baumgartner, William A; Manson, Paul.

In: Plastic and Reconstructive Surgery, Vol. 93, No. 6, 1994, p. 1208-1214.

Research output: Contribution to journalArticle

Ringelman, Paul R. ; Vander Kolk, Craig ; Cameron, Duke ; Baumgartner, William A ; Manson, Paul. / Long-term results of flap reconstruction in median sternotomy wound infections. In: Plastic and Reconstructive Surgery. 1994 ; Vol. 93, No. 6. pp. 1208-1214.
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