[Treatment of refractory sternotomy wound]

To investigate the therapeutic effect of infected incision wounds after sternotomy by using different reconstructive methods.

From December 1997 to December 2006, 13 patients (8 males, 5 females; age, 28-72 years averaged 52 years) with infected incision wounds after sternotomy underwent the reconstruction surgery respectively using the pectoralis major muscle flaps, the medial flaps of the pectoralis major muscle, the rectus abdominis muscle flaps or the greater omentum transpositions. Among the patients, 8 were complicated by diabetes mellitus, 4 by pneumonia and heart failure, 3 by empyema, 4 by chronic insufficiency of the pulmonary function, 1 by malignant tumor, and 6 by severe obesity. Freshly-split wounds were found in 11 patients and chronic wounds in the other 2 patients. The size of the wounds was 10 cm X 5 cm-22 cm X 10 cm.

Among the 13 patients, 10 survived after operation and the other 3 died of massive hemorrhage from the anastomostic rupture of the blood vessel, pneumonia, and cancer metastasis, respectively. Of the 10 patients, 6 had their wounds healed by first intention. The follow-up for 6 months to 5 years revealed that there was no recurrence in all the survived patients. Of the 10 patients, 2 developed partial necrosis of the skins at the sutured wounds, which was healed after the skin grafting operation; 2 had an infection at the drainage area but had a healing after the dressing changes.

The smaller wounds in the upper part of the sternotomy incision should be repaired with the medial flaps of the pectoralis major muscle; the greater wounds in the upper part of the incision should be repaired and reconstructed with the rectus abdominis muscle flap; the smaller wounds in the lower part of the incision should be repaired with the pectoralis major muscle flap, and if the wounds are longer, they should be repaired and reconstructed with the pectoralis major muscle flap and the rectus abdominis muscle flap; and if the wounds are huge enough with an exposure of the important internal organs, the greater omentum transposition should be used, and the residual wounds should be treated with dressing changes and even skin grafting.