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Ann Thorac Surg 2001;72:1419-1429
© 2001 The Society of Thoracic Surgeons

Review

A rational approach to wound difficulties after sternotomy: reconstruction and long-term results

Thomas J. Francel, MDa, Nicholas T. Kouchoukos, MDb

a Department of Surgery, St. Louis University, St. Louis, Missouri, USA
b St John’s Mercy Medical Center, St. Louis, Missouri, USA

Address reprint requests to Dr Francel, 621 S New Ballas Rd, Suite 1009B, St. Louis, MO 63141

One hundred fifty-one patients were reconstructed after median sternotomy by a single plastic surgeon over a 6-year period. The treatment included immediate reconstruction (63 patients) and delayed reconstructions (88 patients). Ninety eight percent of the patients had definitive healing at 6 weeks with an overall 30-day mortality of 4 percent. The issues of long-term intravenous antibiotics, perceived skin deficiency, cardiac decompensation, Candida infections, and reexploration of a healed mediastinum after flap reconstruction are discussed. Follow up (4 months to 6 years) of patients treated with reconstruction compared favorably with patients treated with rewiring procedures (20 patients) in regard to strength, chest wall stability, pulmonary function testing, and functional return to hobbies and employment.




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