Algorithm for classification and treatment of poststernotomy wound infections

Area of Science:

• Thoracic surgery
• Infectious disease
• Plastic surgery

Background:

• Sternal wound infections (SWI) present a significant challenge with high mortality rates.
• Current treatment strategies for SWI lack standardization, ranging from conservative methods to aggressive flap reconstructions.
• A clear classification and treatment algorithm are needed to guide effective management.

Purpose of the Study:

• To propose a modified classification system for SWI.
• To introduce a standardized treatment algorithm for SWI.
• To evaluate the efficacy of the proposed approach, including the use of omental flaps, in a patient cohort.

Main Methods:

• Modification of an existing SWI classification system.
• Development of a treatment algorithm based on the classification.
• Surgical reconstruction in 31 patients, with a focus on radical debridement and selective flap use (omental flap recommended).
• Assessment of patient outcomes, including satisfaction, pain, muscular weakness, and cosmesis.

Main Results:

• Twenty-four out of 31 patients reported high satisfaction with the treatment outcomes.
• Eleven patients experienced residual chest wall pain.
• Eight patients had some degree of muscular weakness.
• Eight patients had less than adequate cosmetic results.
• The omental flap was identified as a suitable option for selected cases.

Conclusions:

• A standardized classification and treatment algorithm can improve SWI management.
• Radical debridement is crucial for successful treatment.
• The omental flap is a valuable reconstructive option for selected SWI patients.
• The proposed selective approach yields good functional and aesthetic results, leading to patient satisfaction.