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The combination of the Negative Pressure Therapy with flap coverages is an accepted technique and one or both Pectoralis Major muscles could be chosen. A multistep protocol was adopted. One hundred and sixty seven patients were treated with the combination of Negative Pressure Therapy with the Pectoralis Major muscle flap: 86 monolateral flap and 81 bilateral flap reconstruction. The main complications (hematoma, seroma, dehiscence, and re\u2010infection), the need for re\u2010intervention, mortality rates, Intensive Care Unit, and hospitalisation time were assessed. The mono\u2010pectoralis group had fewer complications and need for revision, with a shorter hospital stay. A statistically significant difference emerged for the hematoma rate (<jats:italic>P<\/jats:italic> = .0079). Monolateral flap should to be preferred because with the same coverage effectiveness, it guarantees the saving of controlateral muscle with its functionality and the possibility of its use in case of failure. Furthermore, as the technique is less invasive, it can be reserved for more fragile patients.<\/jats:p>","DOI":"10.1111\/iwj.13324","type":"journal-article","created":{"date-parts":[[2020,2,17]],"date-time":"2020-02-17T16:01:47Z","timestamp":1581955307000},"page":"683-691","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Deep sternal wound infection following cardiac surgery: A comparison of the monolateral with the bilateral pectoralis major flaps"],"prefix":"10.1111","volume":"17","author":[{"given":"Federico","family":"Lo Torto","sequence":"first","affiliation":[{"name":"Department of Plastic Reconstructive and Aesthetic Surgery Sapienza Universit\u00e0 di Roma  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3172-5568","authenticated-orcid":false,"given":"Gianmarco","family":"Turriziani","sequence":"additional","affiliation":[{"name":"Department of Plastic Reconstructive and Aesthetic Surgery Sapienza Universit\u00e0 di Roma  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Casella","family":"Donato","sequence":"additional","affiliation":[{"name":"Department of Breast Cancer Surgery Azienda Ospedaliero\u2010Universitaria Senese  Siena Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Marcasciano","sequence":"additional","affiliation":[{"name":"Department of Plastic Reconstructive and Aesthetic Surgery Sapienza Universit\u00e0 di Roma  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ugo","family":"Redi","sequence":"additional","affiliation":[{"name":"Department of Plastic Reconstructive and Aesthetic Surgery Sapienza Universit\u00e0 di Roma  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manfredi","family":"Greco","sequence":"additional","affiliation":[{"name":"Universit\u00e0 degli studi \u201cMagna Graecia\u201d di Catanzaro  Catanzaro Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Miraldi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences Sapienza Universit\u00e0 di Roma  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diego","family":"Ribuffo","sequence":"additional","affiliation":[{"name":"Department of Plastic Reconstructive and Aesthetic Surgery Sapienza Universit\u00e0 di Roma  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,2,17]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)38322-9"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/0196-6553(88)90053-3"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1010-7940(01)00991-5"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2008.08.071"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2009.09.023"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.5935\/1678-9741.20110054"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0b013e31803b370b"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2005.07.002"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2012.04.021"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0031-1275168"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semtcvs.2004.01.006"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/14017430701744469"},{"key":"e_1_2_8_14_1","first-page":"471","article-title":"Mediastinitis after sternotomy. 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