{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T10:23:30Z","timestamp":1788863010664,"version":"build-2803163510"},"reference-count":32,"publisher":"Georg Thieme Verlag KG","issue":"08","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Deep sternal wound complications following sternotomy represent a complex challenge. Management can involve debridement, flap reconstruction, and rigid sternal fixation (RSF). We present our 11-year experience in the surgical treatment of deep sternal wound dehiscence using a standardized treatment algorithm.<\/jats:p><jats:p>\n          Methods\u2003A retrospective review was conducted of all 134 cardiac patients who required operative debridement after median sternotomy at a single institution between October 2007 and March 2019. Demographics, perioperative covariates, and outcomes were recorded. Univariate and subgroup analyses were performed.<\/jats:p><jats:p>\n          Results\u2003One-hundred twelve patients (83.5%) with a deep sternal dehiscence underwent flap closure and 56 (50%) RSF. Of the patients who underwent flap closure, 87.5% received pectoralis advancement flaps. A 30-day mortality following reconstruction was 3.9%. Median length of stay after initial debridement was 8 days (interquartile range: 5\u201315). Of patients with flaps, 54 (48%) required multiple debridements prior to closure, and 30 (27%) underwent reoperation after flap closure. Patients who needed only a single debridement were significantly less likely to have a complication requiring reoperation (N\u2009=\u200910\/58 vs. 20\/54, 17 vs. 37%, p\u2009=\u20090.02), undergo a second flap (N\u2009=\u20096\/58 vs. 17\/54, 10 vs. 32%, p\u2009&lt;\u20090.001), or, if plated, require removal of sternal plates (N\u2009=\u20096\/34 vs. 11\/22, 18 vs. 50%, p\u2009=\u20090.02).<\/jats:p><jats:p>\n          Conclusion\u2003Although sternal dehiscence remains a complex challenge, an aggressive treatment algorithm, including debridement, flap closure, and consideration of RSF, can achieve good long-term outcomes. In low-risk patients, RSF does not appear to increase the likelihood of reoperation. We hypothesize that earlier surgical intervention, before the development of systemic symptoms, may be associated with improved outcomes.<\/jats:p>","DOI":"10.1055\/s-0042-1743167","type":"journal-article","created":{"date-parts":[[2022,3,7]],"date-time":"2022-03-07T07:06:16Z","timestamp":1646636776000},"page":"671-682","source":"Crossref","is-referenced-by-count":9,"title":["An Algorithmic Approach to the Surgical Management of Sternal Dehiscence: A Single-Center Experience"],"prefix":"10.1055","volume":"38","author":[{"given":"Ryan P.","family":"Cauley","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sivana","family":"Barron","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, 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Floros","year":"2011","journal-title":"Heart Lung Circ"},{"issue":"11","key":"ref4","doi-asserted-by":"crossref","first-page":"2673","DOI":"10.1007\/s00268-016-3598-7","article-title":"The impact of deep sternal wound infection on mortality and resource utilization: a population-based study","volume":"40","author":"E D Sears","year":"2016","journal-title":"World J Surg"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1186\/1749-8090-8-132","article-title":"Deep sternal wound infection after cardiac surgery","volume":"8","author":"H Kubota","year":"2013","journal-title":"J Cardiothorac Surg"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1017\/ice.2019.375","article-title":"Preoperative risk stratification of deep sternal wound infection after coronary surgery","volume":"41","author":"F Biancari","year":"2020","journal-title":"Infect Control Hosp 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Sternal wound complications after isolated coronary artery bypass grafting: early and late mortality, morbidity, and cost of care","volume":"49","author":"F D Loop","year":"1990","journal-title":"Ann Thorac Surg"},{"issue":"03","key":"ref10","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1097\/00006534-198909000-00009","article-title":"Primary treatment of the infected sternotomy wound with muscle flaps: a review of 211 consecutive cases","volume":"84","author":"F Nahai","year":"1989","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref11","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1097\/01.prs.0000246492.72037.18","article-title":"Fascial release of the pectoralis major: a technique used in pectoralis major muscle closure of the mediastinum in cases of mediastinitis","volume":"119","author":"A M Spiess","year":"2007","journal-title":"Plast Reconstr Surg"},{"issue":"S 01","key":"ref12","doi-asserted-by":"crossref","first-page":"S27","DOI":"10.1097\/SAP.0000000000000155","article-title":"Rigid fixation for the prevention and treatment of sternal complications","volume":"72","author":"R S Nazerali","year":"2014","journal-title":"Ann Plast Surg"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/1749-8090-4-19","article-title":"Sternal plating for primary and secondary sternal closure; can it improve sternal stability?","volume":"4","author":"H Fawzy","year":"2009","journal-title":"J Cardiothorac Surg"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1097\/00000637-199907000-00005","article-title":"Risk factors for predicting surgical salvage of sternal wound-healing complications","volume":"43","author":"L M Golosow","year":"1999","journal-title":"Ann Plast Surg"},{"issue":"02","key":"ref15","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.ejcts.2004.04.038","article-title":"Primary sternal plating in high-risk patients prevents mediastinitis","volume":"26","author":"D H Song","year":"2004","journal-title":"Eur J Cardiothorac Surg"},{"issue":"05","key":"ref16","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1097\/SAP.0000000000000901","article-title":"Rigid sternal fixation versus modified wire technique for poststernotomy closures: a retrospective cost analysis","volume":"78","author":"J S Park","year":"2017","journal-title":"Ann Plast Surg"},{"issue":"02","key":"ref17","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1093\/ejcts\/ezv060","article-title":"Age-dependent trends in postoperative mortality and preoperative comorbidity in isolated coronary artery bypass surgery: a nationwide study","volume":"49","author":"K Thorsteinsson","year":"2016","journal-title":"Eur J Cardiothorac Surg"},{"issue":"01","key":"ref18","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1055\/s-0031-1275170","article-title":"Workhorse flaps in chest wall reconstruction: the pectoralis major, latissimus dorsi, and rectus abdominis flaps","volume":"25","author":"K Bakri","year":"2011","journal-title":"Semin Plast Surg"},{"issue":"05","key":"ref19","doi-asserted-by":"crossref","first-page":"1584","DOI":"10.1016\/j.athoracsur.2019.12.014","article-title":"Flap reconstruction for deep sternal wound infections: factors influencing morbidity and mortality","volume":"109","author":"W Piwnica-Worms","year":"2020","journal-title":"Ann Thorac Surg"},{"issue":"04","key":"ref20","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1016\/j.bjps.2006.10.005","article-title":"Choice of flap for the management of deep sternal wound infection\u2013an anatomical classification","volume":"60","author":"A V Greig","year":"2007","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"05","key":"ref21","doi-asserted-by":"crossref","first-page":"355","DOI":"10.3109\/2000656X.2013.769441","article-title":"Deep sternal osteomyelitis: an algorithm for reconstruction based on wound width","volume":"47","author":"C Weinand","year":"2013","journal-title":"J Plast Surg Hand Surg"},{"issue":"01","key":"ref22","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1097\/01.PRS.0000127793.77267.DA","article-title":"Sternal wound reconstruction: 252 consecutive cases. 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