Negative Pressure Wound Therapy and Pectoralis Major Myocutaneous Flap in the Treatment of Postoperative Sternal Osteomyelitis after CABG
- VernacularTitle:冠動脈バイパス術後・胸骨骨髄炎に対して局所陰圧閉鎖療法と大胸筋皮弁を施行した2例
- Author:
Shintaro TAKAGO
1
;
Hiroki KATO
1
;
Hideyasu UEDA
1
;
Hironari NO
1
;
Yoshitaka YAMAMOTO
1
;
Keiichi KIMURA
1
;
Kenji IINO
1
;
Hirofumi TAKEMURA
1
Author Information
- Keywords: sternal osteomyelitis; negative pressure wound therapy; pectoralis major myocutaneous flap
- From:Japanese Journal of Cardiovascular Surgery 2019;48(3):179-184
- CountryJapan
- Language:Japanese
- Abstract: We report two cases with postoperative sternal osteomyelitis after coronary artery bypass graft (CABG), in whom successful two-stage reconstruction was performed via negative pressure wound therapy (NPWT) and pectoralis major myocutaneous flaps. Two patients underwent CABG using bilateral internal thoracic arteries, after which they had surgical site infection (SSI). The intractable wound did not heal with irrigation and NPWT. Then, sternal osteomyelitis was observed via magnetic resonance imaging (MRI), so we planned two-stage reconstruction. The first stage of treatment consisted of complete debridement (including removal of sternal wires and necrosectomy of soft tissue and sequestrum) and application of NPWT until the remission of inflammation. The second stage consisted of wound closure with pectoralis major myocutaneous advancement flaps. After wound closure, the two patients were given 2 months of oral antibiotics, and the postoperative results were good. Two-stage reconstruction with NPWT and pectoralis major myocutaneous flaps results in excellent clinical outcome. In the first stage, the key to the successful management of postoperative sternal osteomyelitis is infection control. This includes surgical debridement and wound-bed preparation with NPWT. The pectoralis major myocutaneous flap technique is brief and does not require a second cutaneous incision or an intact internal thoracic artery. In conclusion, the pectoralis major myocutaneous flap is a useful option in two-stage reconstruction after CABG.
