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The Impact of Preoperative Negative-Pressure Wound Therapy on Pectoralis Major Muscle Flap Reconstruction for Deep Sternal Wound Infections

Barbera, Federico MD*†; Lorenzetti, Fulvio MD, PhD*; Marsili, Ricccardo MD*; Lisa, Andrea MD; Guido, Gabriele MD; Pantaloni, Marcello MD*

doi: 10.1097/SAP.0000000000001799
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Background Deep sternal wound infection (DSWI) represents a life-threatening complication following open-heart surgery and pectoralis major muscle flap reconstruction has led to a significant reduction in mortality and morbidity. Negative-pressure wound therapy represented a step forward in DSWI treatment, both as a single procedure or as a preparation for reconstructive surgery.

In the present study, we report our 13 years' experience with sternal reconstruction in order to evaluate the impact of preoperative vacuum-assisted closure (VAC) therapy on reconstructive outcome.

Methods Seventy-three patients diagnosed with DSWI undergoing pectoralis major muscle flap reconstruction were divided into 2 subgroups: preoperative VAC treatment group (n = 37) and no preoperative VAC (NVAC n = 36). We collected patients' DSWI and reconstructive surgery clinical data, and we analyzed surgical outcome in terms of complication rate, reoperation rate, defects closure times, and intraoperative/30-day and 1-year mortality.

Results Eighty-three flaps were used, bilateral flaps were used more in the NVAC subgroup (P = 0.005), and operative time was significantly shorter in the VAC subgroup (P < 0.001). Complication rate was 9.6%, with no significant differences between the 2 subgroups (P = 0.723). There was no recurrence of mediastinitis, and all flaps survived. Sternal closure time was significantly lower in the VAC subgroup (P < 0.001). No intraoperative death occurred; 30-day and 1-year mortality were 2.7% and 19.2%, respectively, with no significant difference between the 2 groups (P = 0.596).

Conclusions Preoperative VAC therapy makes reconstructive surgery easier and faster, even though it has no impact on complication rate and overall success of the reconstruction. Pectoralis major muscle flap represents a reliable solution even if not associated with preoperative VAC.

From the *Plastic and Reconstructive Surgery Unit, University of Pisa, Santa Chiara Hospital; and

Scuola Superiore Sant'Anna di Studi Universitari e Perfezionamento, Pisa; and

University of Milan, Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA–Plastic Surgery Unit, Humanitas Research Hospital, Rozzano, Milan, Italy.

Received September 23, 2018, and accepted for publication, after revision November 24, 2018.

The principles outlined in the Declaration of Helsinki have been followed in this study.

Conflicts of interest and sources of funding: none declared.

Reprints: Federico Barbera, MD, University of Pisa, Plastic and Reconstructive Surgery Unit, Santa Chiara Hospital, Piazza Martiri delle Libertà, 33-56127 Pisa, Italy. E-mail: f.barbera90@gmail.com.

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