Sternal wound types after median sternotomy and reconstruction using dead space-based approach

Area of Science:

• Cardiovascular Surgery
• Plastic Surgery
• Wound Healing

Background:

• Median sternotomy is a common surgical approach for cardiac procedures.
• Wound complications following median sternotomy can be severe and require specialized reconstruction.
• Classifying these complications is essential for developing effective treatment strategies.

Purpose of the Study:

• To classify wound complications after median sternotomy.
• To present an updated reconstructive algorithm for multidisciplinary teams.
• To analyze the effectiveness of different flap reconstructions for various wound types.

Main Methods:

• Retrospective analysis of 15 patients with sternal reconstruction for post-median sternotomy wound complications (August 2020 - October 2023).
• Classification of wounds into Type 1 (skin defect only), Type 2 (partial sternectomy), and Type 3 (total sternectomy) based on debridement-induced dead space.
• Comparison of time to plastic surgery consultation and hospitalization duration.

Main Results:

• Type 2 wounds (partial sternectomy) were most frequent (11 patients).
• Type 1 wounds were reconstructed with superior epigastric artery perforator skin flaps.
• Type 2 wounds utilized bilateral pectoral or split pectoral muscle flaps; Type 3 wounds used rectus abdominis muscle flaps.
• Early plastic surgery consultation correlated with shorter hospital stays.

Conclusions:

• Skin flaps are adequate for Type 1 defects involving only skin and subcutaneous tissue.
• Muscle flaps are necessary for Type 2 and Type 3 defects to fill dead space and protect exposed vital organs after sternal debridement.
• An integrated reconstructive algorithm and early multidisciplinary consultation improve patient management for sternotomy wound complications.