Complication management after interventions on thoracic organs. Deep sternal wound infections

With an incidence rate of 0.5-4 % and a mortality of up to 50 %, deep sternal wound infections are a rare but devastating complication after median sternotomy for cardiac surgery. Currently, no standard operating procedures exist. Long-term drainage with continuous lavage or negative pressure wound therapy should be used to condition the wound. After restabilization of the sternum and primary closure, the infection often reoccurs presenting deep cavities with an open, unstable thorax and an uncovered mediastinum. This article gives an overview of the different options for deep sternal wound infections in plastic reconstructive surgery. The key point for successful treatment is still the extent of debridement. Primary coverage with a pedicled flap can be made only if the wound debridement was performed radically enough. In the clinic of the author, in which over 120 patients with deep sternal wound infections were treated in 2.5 years, latissimus dorsi muscle flaps have been established as the gold standard.