Book contents
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Introduction
- Part 1 Perioperative Care of the Surgical Patient
- Part 2 Surgical Procedures and their Complications
- Section 17 General Surgery
- Section 18 Cardiothoracic Surgery
- Section 19 Vascular Surgery
- Section 20 Plastic and Reconstructive Surgery
- Chapter 90 Breast reconstruction after mastectomy
- Chapter 91 Facial rejuvenation
- Chapter 92 Liposuction
- Chapter 93 Facial fractures
- Chapter 94 Flap coverage for pressure ulcers
- Chapter 95 Muscle flap coverage of sternal wound infections
- Chapter 96 Skin grafting for burns
- Section 21 Gynecologic Surgery
- Section 22 Neurologic Surgery
- Section 23 Ophthalmic Surgery
- Section 24 Orthopedic Surgery
- Section 25 Otolaryngologic Surgery
- Section 26 Urologic Surgery
- Index
- References
Chapter 95 - Muscle flap coverage of sternal wound infections
from Section 20 - Plastic and Reconstructive Surgery
Published online by Cambridge University Press: 05 September 2013
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Introduction
- Part 1 Perioperative Care of the Surgical Patient
- Part 2 Surgical Procedures and their Complications
- Section 17 General Surgery
- Section 18 Cardiothoracic Surgery
- Section 19 Vascular Surgery
- Section 20 Plastic and Reconstructive Surgery
- Chapter 90 Breast reconstruction after mastectomy
- Chapter 91 Facial rejuvenation
- Chapter 92 Liposuction
- Chapter 93 Facial fractures
- Chapter 94 Flap coverage for pressure ulcers
- Chapter 95 Muscle flap coverage of sternal wound infections
- Chapter 96 Skin grafting for burns
- Section 21 Gynecologic Surgery
- Section 22 Neurologic Surgery
- Section 23 Ophthalmic Surgery
- Section 24 Orthopedic Surgery
- Section 25 Otolaryngologic Surgery
- Section 26 Urologic Surgery
- Index
- References
Summary
The median sternotomy was first described by Julian in 1957 for use in cardiac surgery. A 5% sternal wound infection rate was reported, and the treatment of choice was debridement and open packing. Since that time, management of sternal wounds has changed drastically. Shumacker and Mandelbaum introduced the closed-chest catheter irrigation system in 1963 and reduced mortality from 50 to 20%. The pedicled omental flap was advocated by Lee et al. in 1976. A few years later, Jurkiewicz et al. revolutionized the treatment algorithm with the introduction of muscle flaps.
Sternal wound infections are divided into superficial (affecting the skin, subcutaneous tissue, and pectoralis fascia only) and deep. It is important to recognize patient risk factors (including, but not limited to): BMI > 30 kg/m2, diabetes mellitus, urgent operation, sepsis/endocarditis after surgery, smoking history within one year, COPD, renal insufficiency, and history of stroke. The most commonly isolated pathogen is coagulase-negative staphylococcus, followed by Staphylococcus aureus, Propioni, Acinetobacter, Enterobacter cloacae, Escherichia coli, and Klebsiella. There is a subset of patients who never grow bacteria; they are deemed to have non-infectious sternal dehiscence.
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- Information
- Medical Management of the Surgical PatientA Textbook of Perioperative Medicine, pp. 647 - 648Publisher: Cambridge University PressPrint publication year: 2013