{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T08:33:40Z","timestamp":1740126820604,"version":"3.37.3"},"reference-count":54,"publisher":"Georg Thieme Verlag KG","issue":"08","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Adequate treatment of deep sternal wound infections (DSWIs) after open thoracic surgery still presents a major challenge. This study retrospectively analyzes the results of a single center's 12-year experience in treating DSWI, with special emphasis on free flap reconstruction.<\/jats:p><jats:p>\n          Methods\u2003In this single-center, retrospective study, all patients admitted with the diagnosis of DSWI after open thoracic surgery between 2009 and 2020 were included. A comparative analysis was performed between: (1) pedicled versus free flaps, (2) the center's two workhorse flaps\u2014the pedicled latissimus dorsi (pLD) versus free anterolateral thigh (fALT) flaps, as well as (3) myocutaneous (MC) versus fasciocutaneous (FC) flaps. Primary endpoints were length of hospital stay (LOS) after reconstruction and in-hospital mortality.<\/jats:p><jats:p>\n          Results\u2003Of a total of 165 patients included, 152 underwent DSWI defect reconstruction with a total of 12 different reconstruction methods. Although the defect size was larger in patients who underwent free flap coverage, and the risk profile in the fALT and FC flap groups was higher, the LOS after reconstruction (in days) did not differ significantly between the groups (pedicled vs. free flaps: 23 vs. 28, p\u2009&gt;\u20090.05; pLD vs. fALT: 24.5 vs. 26, p\u2009&gt;\u20090.05; MC vs. FC flaps: 23 vs. 26, p\u2009&gt;\u20090.05). Also, no significant differences were found in terms of in-hospital mortality when comparing the groups (pedicled vs. free flaps: 11.2 vs. 17.4%, p\u2009&gt;\u20090.05; pLD vs. fALT: 11.5 vs. 12.5%, p\u2009&gt;\u20090.05; MC vs. FC flaps: 12.9 vs. 12.5%, p\u2009&gt;\u20090.05).<\/jats:p><jats:p>\n          Conclusion\u2003With proper patient selection, free tissue transfer is a valuable alternative in the treatment of sternal dehiscence after a DSWI. Furthermore, our data demonstrate that MC flaps are not necessarily superior to FC flaps in the reconstruction of sternal osteomyelitis defects.<\/jats:p>","DOI":"10.1055\/s-0043-1761208","type":"journal-article","created":{"date-parts":[[2023,1,24]],"date-time":"2023-01-24T23:38:55Z","timestamp":1674603535000},"page":"601-615","source":"Crossref","is-referenced-by-count":2,"title":["Free Flaps in Sternal Osteomyelitis After Median Sternotomy: A Center's 12-Year Experience"],"prefix":"10.1055","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1693-3572","authenticated-orcid":false,"given":"Iakovos","family":"Georgiou","sequence":"additional","affiliation":[{"name":"Department of Plastic, Aesthetic and Reconstructive Microsurgery\/Hand Surgery, Hospital Ernst von Bergmann, Potsdam, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christos I.","family":"Ioannou","sequence":"additional","affiliation":[{"name":"CYENS \u2013 Centre of Excellence, Nicosia, Cyprus"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremias","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Plastic, Aesthetic and Reconstructive Microsurgery\/Hand Surgery, Hospital Ernst von Bergmann, Potsdam, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Eschborn","sequence":"additional","affiliation":[{"name":"Department of Plastic, Aesthetic and Reconstructive Microsurgery\/Hand Surgery, Hospital Ernst von Bergmann, Potsdam, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giw","family":"Mostofizadeh-Haghighi","sequence":"additional","affiliation":[{"name":"Department of Plastic, Aesthetic and Reconstructive Microsurgery\/Hand Surgery, Hospital Ernst von Bergmann, Potsdam, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manfred","family":"Infanger","sequence":"additional","affiliation":[{"name":"Clinic for Plastic, Aesthetic and Hand Surgery, Otto-von-Guericke-University, Magdeburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mojtaba","family":"Ghods","sequence":"additional","affiliation":[{"name":"Department of Plastic, Aesthetic and Reconstructive Microsurgery\/Hand Surgery, Hospital Ernst von Bergmann, Potsdam, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp","family":"Kruppa","sequence":"additional","affiliation":[{"name":"Department of Plastic, Aesthetic and Reconstructive Microsurgery\/Hand Surgery, Hospital Ernst von Bergmann, Potsdam, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,1,24]]},"reference":[{"issue":"06","key":"ref1","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1016\/S0022-5223(96)70222-2","article-title":"Risk factors for deep sternal wound infection after sternotomy: a prospective, multicenter study","volume":"111","author":"Parisian Mediastinitis Study Group","year":"1996","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/S0196-6553(99)70088-X","article-title":"Guideline for prevention of surgical site infection, 1999","volume":"27","author":"A J Mangram","year":"1999","journal-title":"Am J Infect Control"},{"issue":"05","key":"ref3","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1016\/S0003-4975(10)60767-9","article-title":"A prospective study of sternal wound complications","volume":"37","author":"R H Breyer","year":"1984","journal-title":"Ann Thorac Surg"},{"issue":"06","key":"ref4","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1097\/00000658-196906000-00011","article-title":"Treatment of median sternotomy infection by mediastinal irrigation with an antibiotic solution","volume":"169","author":"L R Bryant","year":"1969","journal-title":"Ann Surg"},{"issue":"04","key":"ref5","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1016\/S0022-5223(19)38565-4","article-title":"Comparison between antibiotic irrigation and mobilization of pectoral muscle flaps in treatment of deep sternal infections","volume":"90","author":"H E Scully","year":"1985","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1067\/mtc.2003.74","article-title":"Vacuum-assisted closure as a treatment modality for infections after cardiac surgery","volume":"125","author":"H Luckraz","year":"2003","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1016\/S0022-5223(03)00352-0","article-title":"Evaluation of vacuum-assisted closure in the treatment of poststernotomy mediastinitis","volume":"126","author":"P W Domkowski","year":"2003","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"06","key":"ref8","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1097\/00000658-198006000-00012","article-title":"Infected median sternotomy wound. 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artery","volume":"37","author":"Y G Song","year":"1984","journal-title":"Br J Plast Surg"},{"issue":"03","key":"ref33","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/0007-1226(89)90142-2","article-title":"The anterolateral thigh flap; variations in its vascular pedicle","volume":"42","author":"I Koshima","year":"1989","journal-title":"Br J Plast Surg"},{"key":"ref34","first-page":"e21","article-title":"Versatility of the anterolateral thigh free flap: the four seasons flap","volume":"12","author":"M Di Candia","year":"2012","journal-title":"Eplasty"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"11.IT.3.1","DOI":"10.2466\/11.it.3.1","article-title":"The simple difference formula: an approach to teaching nonparametric correlation","volume":"3","author":"D S Kerby","year":"2014","journal-title":"Compr Psychol"},{"issue":"01","key":"ref36","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.jss.2014.09.044","article-title":"Complications after 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Mathes","year":"1982","journal-title":"Plast Reconstr Surg"},{"issue":"06","key":"ref40","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1097\/SAP.0b013e31821ee359","article-title":"A modified free muscle transfer technique to effectively treat chronic and persistent calcaneal osteomyelitis","volume":"68","author":"M Ghods","year":"2012","journal-title":"Ann Plast Surg"},{"issue":"06","key":"ref41","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.1097\/01.prs.0000239579.37760.92","article-title":"Muscle versus nonmuscle flaps in the reconstruction of chronic osteomyelitis defects","volume":"118","author":"C J Salgado","year":"2006","journal-title":"Plast Reconstr Surg"},{"issue":"07","key":"ref42","doi-asserted-by":"crossref","first-page":"2468","DOI":"10.1097\/01.prs.0000224304.56885.c2","article-title":"Outcome comparison between free muscle and free fasciocutaneous flaps for reconstruction of distal third and ankle traumatic open tibial 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Etiology, diagnostics and operative therapy concepts [in German]","volume":"85","author":"J Hauser","year":"2014","journal-title":"Chirurg"},{"issue":"06","key":"ref49","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1097\/00000658-199106000-00008","article-title":"Long-term results of pectoralis major muscle transposition for infected sternotomy wounds","volume":"213","author":"P C Pairolero","year":"1991","journal-title":"Ann Surg"},{"issue":"09","key":"ref50","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1055\/s-0039-1695089","article-title":"Unilateral pedicled pectoralis major harvested by endoscopic-assisted method achieves adequate management of sternal infection and mediastinitis","volume":"35","author":"C-H Lin","year":"2019","journal-title":"J Reconstr Microsurg"},{"issue":"05","key":"ref51","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1097\/SAP.0000000000002581","article-title":"Extending the indication of the superior thyroid artery as a recipient vessel for complex upper body defects","volume":"86","author":"D Ehrl","year":"2021","journal-title":"Ann Plast Surg"},{"issue":"05","key":"ref52","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1016\/j.athoracsur.2015.01.078","article-title":"Treatment of sternal wound infection using a free myocutaneous flap","volume":"100","author":"I H Chiang","year":"2015","journal-title":"Ann Thorac Surg"},{"issue":"01","key":"ref53","doi-asserted-by":"crossref","first-page":"3","DOI":"10.3109\/14017439309099086","article-title":"The role of the internal thoracic artery in the sternal blood supply","volume":"27","author":"F W Knudsen","year":"1993","journal-title":"Scand J Thorac Cardiovasc Surg"},{"issue":"04","key":"ref54","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1007\/s12055-019-00880-5","article-title":"Sternal reconstruction after post-sternotomy dehiscence and mediastinitis","volume":"36","author":"A Dell'Amore","year":"2020","journal-title":"Indian J Thorac Cardiovasc Surg"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0043-1761208.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T23:30:41Z","timestamp":1694647841000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0043-1761208"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,24]]},"references-count":54,"journal-issue":{"issue":"08","published-online":{"date-parts":[[2023,9,13]]},"published-print":{"date-parts":[[2023,10]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0043-1761208","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"type":"print","value":"0743-684X"},{"type":"electronic","value":"1098-8947"}],"subject":[],"published":{"date-parts":[[2023,1,24]]}}}