{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T17:09:45Z","timestamp":1774717785062,"version":"3.50.1"},"reference-count":39,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Deep sternal wound infections (DSWIs) remain a serious complication after median sternotomy, often requiring complex wound management strategies. While modern approaches include vacuum-assisted closure (VAC) and plating techniques, the pedicled pectoralis major muscle flap (PMF) continues to play a pivotal role in surgical reconstruction, especially in cases with sternal destruction or osteomyelitis. Methods: In this retrospective single-centre analysis, 166 patients with DSWI following cardiac surgery were reviewed. Clinical data, comorbidities, laboratory parameters, and surgical management were evaluated. Logistic regression was performed to assess predictors for reinfection and need for reoperation. Results: Initial wound revision was most frequently performed using sternal rewiring (60.2%), followed by reconstruction with a pectoralis major flap (33.7%). Despite initial surgical treatment, 27.1% of patients developed post-revision wound healing disturbances, and 24.1% ultimately required a second surgical intervention. Among second-time procedures, VAC therapy (32.5%) and PMF reconstruction (20.0%) were the most common approaches. Reinfection was significantly associated with higher preoperative EuroSCOREs (p = 0.044), while initial rewiring carried a higher risk of treatment failure compared to the pectoralis major flap (p = 0.0024). Conclusions: In the setting of sternal destruction or osteomyelitis, the pectoralis major muscle flap remains a fast, effective, and robust solution. Despite its long-standing use, it continues to offer excellent vascularized coverage and infection control in complex DSWI cases.<\/jats:p>","DOI":"10.3390\/jcm14238376","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T11:43:22Z","timestamp":1764157402000},"page":"8376","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["When Rewiring Fails\u2014The Enduring Role of the Pectoralis Major Flap in Sternal Wound Reconstruction"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-9237-0683","authenticated-orcid":false,"given":"Viktoria","family":"Koenig","sequence":"first","affiliation":[{"name":"Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6827-4110","authenticated-orcid":false,"given":"Alexandra","family":"Christ","sequence":"additional","affiliation":[{"name":"Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maximilian","family":"Monai","sequence":"additional","affiliation":[{"name":"Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4950-5432","authenticated-orcid":false,"given":"Martin","family":"Andreas","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Medical University Graz, Neue Stiftingtalstra\u00dfe 6, 8010 Graz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Zimpfer","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wolfgang","family":"Happak","sequence":"additional","affiliation":[{"name":"Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0925-6160","authenticated-orcid":false,"given":"Paul","family":"Werner","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,26]]},"reference":[{"key":"ref_1","first-page":"212","article-title":"Deep Sternal Wound Infection (DSWI) and Mediastinitis After Cardiac Surgery: Current Approaches and Future Trends in Prevention and Management","volume":"36","author":"Chello","year":"2020","journal-title":"Surg. 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