Using Titanium Plate with Muscle Flap in Difficult Sternal Wound Reconstruction

Background: Deep sternal wound infection (DSWI) following median sternotomy is a rare but potentially fatal disease, with reported incidence of 0.2-8%, and mortality rate up to 47%. The management of DSWI poses a challenge to the treating surgeons due to problematic wound healing accompanied by intractable or recurrent sternal osteomyelitis. Aim and Objectives: The purpose of this study was to examine our outcomes of sternal reconstruction with titanium reconstruction plates and muscle flaps. Materials and Methods: From April 1997 to April 2013, 12 patients with difficult sternal wounds and sternal instability after median sternotomy were reconstructed with titanium plates and muscle flaps. In a retrospective review, the comorbidities, clinical course of disease, method, outcome and complications of reconstruction were analyzed. Results: Among the 12 patients with post-sternotomy DSWI, all exhibited sternal dehiscence and instability. Six of the patients had failed attempts to restore sternal stability, despite rewiring with the reinforced Robicsek parasternal weaving technique. Following sternal fixation with titanium reconstruction plates and muscle flaps coverage, sternal stability was achieved in 10 surviving patients (2 multi-morbid patients expired at 3 days and 31 days after reconstruction). There was no recurrence of sternal osteomyelitis in the mean follow-up period of 16 months (range, 2-56 months). The mean postoperative ICU stay in 10 surviving patients was 8.7 days (range, 2-32days). Five patients were able to wean off the ventilator on postoperative day 1, and 4 patients were able to wean off the ventilator within one week. Only 1 patient with pre-existing pneumonia failed to wean off the ventilator after reconstruction. Postoperative complications, including pneumothorax in 1 patient, seroma in 1 patient, and superficial wound dehiscence in 4 patients, were manageable with simple modalities. Conclusion: Sternal plating with muscle flap reconstruction is an effective treatment strategy for difficult sternal wounds to restore sternal stability and facilitate the control of sternal wound infection.