Background: Deep sternal wound infection (DSWI) is one of the most feared complications in patients undergoing cardiac surgery with decreasing long and short term survival, increasing hospitalization period and severely impaired quality of life.
Common surgical technique includes sternectomy covered by pectoral muscle or omentum flaps yet with unsatisfying results including reinfections and redehiscences with high rates of morbidity and mortality.
A major reason for failure of this technique is the chest wall mass which causes tension and huge breathing and coughing shear forces loaded on that flaps which cause it to redehisce.
We developed an innovative surgical chest wall closure technique which reduces both the tension and the overload and split it between the muscle flaps and the bone structures (sternal edges and the ribs).
This technique consists of sternectomy, followed by chest wall reconstruction with bilateral mid clavicular line longitudinal wires reinforcement technique (Robicsek) , tightened by 6-8 single sternal wires encircled laterally to the longitudinal wires away from the infected zone.
That built- up structure is additionally reinforced with bilateral pectoralis muscle flaps which makes that a well fixed solid structure almost impossible to be dehisced.
Method: Between 2011 and 2014 we operated 31 patients with DSWI and fully dehisced sternum from 7 different medical centres from Israel and abroad using that innovative technique.
Results: Mean patients age and hospital stay were 73 year old and 16 days respectively.
In up to 3 years follow up there was one post-operative death caused by uncontrolled sepsis. Intra and post-operative complications included one right ventricular rupture and two superficial wound reinfections successfully treated conservatively.
Conclusion: Although surgically demanding, that innovative technique provides very good clinical outcome lowering morbidity and mortality and became the common surgical approach for that complicated group of patients at our institute.
