Objective:

Since deep sternal wound infections following sternotomy is a life-threatening complication, optimal management of sternal wounds still of vital importance.

This study presents our 10-year experience with the use of pediculated muscle flaps and multiple Z-plasty techniques in reconstruction and tension-free closure of deep sternal wound and skin defects.

Material and Method:

14 patients with deep sternal wound infection referred to our clinic between 2006 and 2016 for the closure of their defects included in our study. Following aggressive debridement, all patients underwent closure of mediastinal defect using pediculated muscle flaps, whereas primary skin repair was performed in seven patients and another seven patients required multiple Z-plasties due to high skin tension.

Results:

The tension-free closure was performed in all patients. None of the patients developed muscle or skin flap necrosis. Of a total of three patients with postoperative complications, two of them developed seroma and one patient developed a hematoma. At a mean follow-up period of five years recovery was achieved with acceptable wound scar in patients who underwent repair with multiple Z-plasty techniques.

Conclusion:

Aggressive therapy with muscle flap reconstruction serves to reduce morbidity and mortality caused by sternal wound infection, whereas successful use of multiple Z-plasty techniques for skin closure allows the surgeon to perform tension-free closure and reduces the risk of skin necrosis, dehiscence and infections.

Keywords: sternal wound infection, dehiscence, multiple Z-plasty