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Failure of Secondary Wound Closure After Sternal Wound Infection Following Failed Initial Operative Treatment: Causes and Treatment

Phan, Truong Q. V. MD; Depner, Christian MD, MBA; Theodorou, Panagiotis MD; Lefering, Rolf PhD; Perbix, Walter MD; Spilker, Gerald MD, PhD; Weinand, Christian MD, PhD

doi: 10.1097/SAP.0b013e31823b67ec
Reconstructive Surgery

Background Patients transferred to Plastic Surgery Departments for sternum osteomyelitis have a high morbidity of about 3%. Despite several known options for sternal wound coverage and salvage operations, wound dehiscence or wound necrosis can occur, increasing patient morbidity.

Patients and Methods One hundred thirty-five patients admitted between January 2007 and December 2010 were evaluated in a retrospective study for wound dehiscence after salvage wound coverage at our institution. Various flaps were applied, such as pectoralis major myocutaneous pedicled flaps, pectoralis major muscle pedicled flaps, latissimus dorsi pedicled flaps, greater omental flaps, and vertical rectus abdominis muscle and transverse rectus abdominis muscle flaps. Inclusion criteria were sternal wound infection, bacterial wound infection, previous wound debridement outside our institution, vacuum-assisted closure device wound treatment at our institution, and secondary flap closure of the sternal defect at our institution. A multivariate regression analysis was performed.

Results One hundred thirty patients met the inclusion criteria. In all patients, bacterial wound colonization was shown. Forty patients showed wound dehiscence after closure at our institution. Reasons for wound dehiscence were attributed to wound size, >4 different species of bacteria colonizing the wound, gram-negative bacteria, Candida albicans, intensive care unit stay, and female gender. Interestingly, wound dehiscence was not significant correlated to obesity, smoking, atherosclerosis, renal insufficiency or type of closure influenced significantly, or necrosis.

Conclusions Female patients after CABG, with large sternal wounds infected with gram-negative bacteria and candida, have an 85% risk of wound dehiscence after flap coverage for sternal wound infection.

From the *Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Burns, University Hospital Cologne-Merheim, Germany; †Institute for Research in Operative Medicine (IFOM), University Hospital Cologne-Merheim, Germany; ‡Department for Cardiothoracic Surgery, University of Cologne, Cologne, Germany; and §Department for Cardiovascular Surgery, University of Düsseldorf, Düsseldorf, Germany.

Received July 23, 2011, and accepted for publication, after revision, October 4, 2011.

Conflicts of interest and sources of funding: none declared.

Reprints: Christian Weinand, MD, PhD or T. Q. Vu Phan, MD, Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Burns, Universitätsklinik Standort Köln-Merheim, Ostmerheimer Str. 200, 51109 Köln-Merheim. E-mail: or

© 2013 Lippincott Williams & Wilkins, Inc.