Sternotomy Wound Closure: Equivalent Results with Less Surgery.

Area of Science:

• Thoracic surgery
• Surgical reconstruction
• Wound healing

Background:

• Mediastinitis following median sternotomy presents a life-threatening risk.
• Pedicle flap treatments improved outcomes but can cause significant morbidities, especially in patients with comorbidities.
• A modified subpectoral approach was developed to minimize surgical dissection and address sternal closure challenges.

Purpose of the Study:

• To evaluate the safety and efficacy of a modified subpectoral approach for sternal closure.
• To assess complication rates associated with this minimally invasive technique.
• To compare outcomes with more extensive sternal closure procedures.

Main Methods:

• A retrospective review of 58 consecutive patients undergoing the modified subpectoral approach between 2008 and 2019.
• The technique involved limited pectoralis major muscle dissection, no skin undermining, and midline closure with suction drains.
• Procedures were standardized regardless of illness severity, tissue loss extent, or sternal defect size.

Main Results:

• No operative mortalities were observed in the study cohort.
• Reoperations were required in 7 patients (12%), with only 4 (6.9%) related to sternal osteomyelitis.
• Other reoperations addressed hematoma, breast fat necrosis, and skin necrosis.

Conclusions:

• Chest closure utilizing minimal dissection and tension release is a safe and efficient surgical strategy.
• This approach demonstrates a complication rate equivalent to more extensive procedures.
• The technique is effective even in patients with significant comorbidities and complex sternal defects.