Management of recalcitrant median sternotomy wounds

During a 7 year period, 38 consecutive patients (31 male and seven female) had repair of an infected sternotomy wound. Their mean age was 56 years (range 13 to 78 years). Sternotomy was performed for cardiac disease in 34 patients. Staphylococcus aureus was the most commonly cultured organism. All patients required sternal debridement, and 17 had resection. Reconstruction was with muscle flaps in 37 patients, omental transposition in one, and both in four. Sixty-seven muscle transpositions were performed (63 pectoralis major, three rectus abdominis, and one latissimus dorsi). The mean number of operations was three (range one to seven). No deaths occurred within 30 days postoperatively. Significant early complications occurred in nine patients. The mean duration of hospitalization was 24.9 days (range 8 to 67 days). All patients were dismissed with a healed sternum. The mean length of follow-up was 24.8 months (range 1 to 81 months). None of the five late deaths were related to sepsis or to wound reconstruction. Recurrent sternal infection occurred in five patients (13.2%). Four of the five patients responded to additional debridement and muscle transposition, and the fifth patient refused further treatment. Of the 38 patients, 33 were alive at the time of this report, 32 with excellent results. We conclude that muscle transposition is an excellent method of management for recalcitrant median sternotomy wounds.