Secondary omental and pectoralis major double flap reconstruction following aggressive sternectomy for deep sternal wound infections after cardiac surgery

<p>Abstract</p> <p>Background</p> <p>Deep sternal wound infection after cardiac surgery carries high morbidity and mortality. Our strategy for deep sternal wound infection is aggressive strenal debridement followed by vacuum-assisted closure (VAC) therapy and omental-muscle flap reconstrucion. We describe this strategy and examine the outcome and long-term quality of life (QOL) it achieves.</p> <p>Methods</p> <p>We retrospectively examined 16 patients treated for deep sternal wound infection between 2001 and 2007. The most recent nine patients were treated with total sternal resection followed by VAC therapy and secondary closure with omental-muscle flap reconstruction (recent group); whereas the former seven patients were treated with sternal preservation if possible, without VAC therapy, and four of these patients underwent primary closure (former group). We assessed long-term quality of life after DSWI by using the Short Form 36-Item Health Survey, Version 2 (SF36v2).</p> <p>Results</p> <p>One patient died and four required further surgery for recurrence of deep sternal wound infection in the former group. The duration of treatment for deep sternal wound infection in the recent group was significantly shorter than that in previous group (63.4 ± 54.1 days vs. 120.0 ± 31.8 days, respectively; p = 0.039). Despite aggressive sternal resection, the QOL of patients treated for DSWI was only minimally compromised compared with age-, sex-, surgical procedures-matched patients without deep sternal wound infection.</p> <p>Conclusions</p> <p>Aggressive sternal debridement followed by VAC therapy and secondary closure with an omental-muscle flap is effective for deep sternal wound infection. In this series, it resulted in a lower incidence of recurrent infection, shorter hospitalization, and it did not compromise long-term QOL greatly.</p

Diabetic foot infections: a team-oriented review of medical and surgical management

As the domestic and international incidence of diabetes and metabolic syndrome continues to rise, health care providers need to continue improving management of the long-term complications of the disease. Emergency department visits and hospital admissions for diabetic foot infections are increasingly commonplace, and a like-minded multidisciplinary team approach is needed to optimize patient care. Early recognition of severe infections, medical stabilization, appropriate antibiotic selection, early surgical intervention, and strategic plans for delayed reconstruction are crucial components of managing diabetic foot infections. The authors review initial medical and surgical management and staged surgical reconstruction of diabetic foot infections in the inpatient setting

Effects of University of Wisconsin and lactated Ringer's solutions to ischemia-reperfusion injury in isolated cremaster flap

WOS: 000174592400006PubMed ID: 11921074Ischemia-reperfusion (I/R) injury is a topic that has been much-discussed by various researchers during the last decade in plastic surgery. Though much progress has occurred, the problem is not totally solved yet. In particular, the pathophysiology of reperfusion injury in skeletal muscle has not been clearly elucidated. The aims of this study are to assess the effects of a variety of perfusants on the microcirculation after reperfusion injury and to better understand the pathophysiology of reperfusion injury. Isolated cremaster flaps were performed in 44 rats, preserving the femoral artery and vein in order to cannulate with microtubes. There were 2 control and 2 experiment groups. In one of the control groups and in both experimental groups, 2 h of ischemia were applied by clamping the iliac vessels. Immediately after this, the muscle was locally perfused and washed with lactated Ringer's (LR) and University of Wisconsin (UW) solutions, given from the femoral artery and drained by the femoral vein in the two respective experimental groups. The effects of these solutions to I/R injury were shown at the microcirculatory level via measuring and determining preischemic and postischemic diameters of arterioles and venules, tissue perfusion, capillary density, velocity of red blood cells, and leukocyte sticking. Both tested perfusion solutions were found to be harmful in all parameters. This study demonstrates that both LR and UW solutions aggravate I/R injury. (C) 2002 Wiley-Liss, Inc