An Institutional Analysis of Risk Factors in Pectoralis Advancement Flap Reconstruction

Between 1996 and 2004, 21 patients at the Birmingham Veterans Affairs Medical Center (BVA) underwent bilateral pectoralis flap reconstruction for treatment of post sternotomy sternal wound infection.

Data from the University of Alabama Birmingham (UAB) Medical Center were used to create a cohort group of 29 patients similar to the BVA group with respect to cardiac procedure, reconstruction type, demographics, and preoperative risk factors, such as diabetes, renal function, and nutritional status. The same surgeons performed the cardiac and reconstructive procedures at both institutions.

Numerical comparison shows higher mortality in the BVA group (19.0% versus 6.9% at UAB, P = 0.22). It was also noted that the BVA group had a longer post-cardiac operation length of stay ([LOS], 21.8 versus 8.9 days, P = 0.03) and a longer post-reconstruction LOS (17.2 versus 9.5 days, P = 0.01). There were 3 patients in the BVA group who died of sepsis, while there were no sepsis-related deaths in the UAB group.

The outcome differences between these 2 groups suggest that BVA patients presented with later more advanced sternal wound infections. Possible explanations include differences in patient populations, critical care, and referral networks. These findings further emphasize the importance of early diagnosis and treatment in sternal wound management.