Purpose: Because life-threatening sternal wound complications can occur following sternotomy, the optimal management of sternal wound infections remains an important topic. To decrease morbidity following operative treatment of these patients, we made a number of refinements in our treatment protocol over the past several years, particularly with regard to the extent of debridement, method of flap apposition, and management of drains. The purpose of this study was to obtain specific outcomes data by reviewing a large series of patients treated by a single surgeon. Methods: In this series of 114 consecutive sternal wounds treated by the senior author, patients were treated almost exclusively with debridement and immediate closure with bilateral pectoralis major myocutaneous advancement flaps, regardless of the degree of infection. Inferiorly, the anterior rectus fascia was raised with the flaps. Fifteen patients were immunosuppressed heart transplant recipients, and 38 were diabetic. All data were obtained through record and chart review. Minimum follow-up time was one year. Results: There were no intraoperative deaths. The 30-day perioperative mortality rate was 7.9%, with only one death directly related to sternal infection. Nineteen patients (16.7%) experienced postoperative morbidity, including partial wound dehiscences (5 percent), skin edge necrosis (5 percent), and seromas (3.5 percent). There were no hematomas. Conclusions: We advocate single-stage management of complicated sternal wounds with immediate debridement and bilateral pectoralis major myocutaneous advancement flaps. The procedure is rapid and effective. Refinements in technique, all of which will be presented, have significantly lowered our morbidity. Intact internal mammary arteries, which are often used for coronary artery bypass grafts, are not necessary. Inclusion of the rectus fascia with the flaps helps avoid wound healing problems in the xiphoid region. Furthermore, chest wall contour is preserved, the anterior axillary fold is not disturbed, and pectoralis major function is maintained.
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