Predictors of Major and Minor Complications Following Sternal Wound Reconstruction: A Thirty-Year Experience

Deep sternal wound complications following cardiac surgery are associated with significant morbidity and mortality. This study presents a 30-year single-institution experience to identify predictors of outcomes following sternal wound reconstruction.

A retrospective review was conducted of 584 patients who underwent sternal reconstruction between 1995 and 2024. Data collected included demographics, comorbidities, reconstruction indications, surgical approach, and timing. Primary outcomes were 30-day complications, reoperations, and mortality. Multivariate analyses identified independent predictors.

Coronary artery bypass grafting (67.0%) was the most common index cardiac surgery, while wound dehiscence (67.0%) and culture-positive infection (56.3%) were leading reconstruction indications. The majority (99.3%) were treated with bilateral pectoralis major flaps. Overall complication rate was 42.12%, with reoperation at 11.8% and 30-day mortality at 6.9%. Chronic kidney disease, end-stage renal disease, and diabetes mellitus were significantly associated with higher complication rates. Longer intervals between index cardiac surgery and reconstruction correlated with increased complications (41 vs. 27 days, p = 0.0002). Use of omental flaps, surgical staging, and specific reconstruction indications-such as bone dehiscence and sternal instability-were also independently predictive of complications. Over time, patients presented with more comorbidities, yet experienced reduced length of stay and improved 30-day mortality (10.3% to 4.8%, p = 0.0441).

Despite increasing patient complexity, standardization with bilateral pectoralis flaps and improved perioperative protocols have enhanced outcomes. Delayed reconstruction is associated with increased complications, supporting the importance of early intervention, multidisciplinary coordination, and targeted strategies for high-risk patients.