Thorac Cardiovasc Surg 2015; 63 - OP88
DOI: 10.1055/s-0035-1544340

Complications after Myocutaneous Flap Surgery in Patients with Mediastinitis and Sternal Resection after Cardiac Surgery

F. Schlingloff 1, M. Oberhoffer 1, L. Schäkel 1, J. von Freyhold-Hünecken 2, J. Elsner 2, M. Schmoeckel 1
  • 1AK St. Georg, Herzchirurgie, Hamburg, Germany
  • 2Asklepios Klinik Harburg, Plastische und Rekonstruktive Chirurgie, Hamburg, Germany

Objective: Mediastinitis is a serious complication after cardiac surgery with a reported mortality of up to 47%, especially when sternectomy and myocutaneous flap surgery are required. Complications after plastic surgery and their impact on health care and patients regarding operative re- intervention and prolonged and recurrent in-hospital stay have rarely been described.

Methods: We prospectively collected data on 83 patients with mediastinitis and sternectomy following cardiac surgery who underwent chest wall reconstruction with myocutaneous flaps at our institution between 01/2009 and 09/2014. Postoperative complications in terms of wound infections, tissue necrosis, repeat Vacu-Seal therapy and fistulas were documented.

Results: Mean age in our group was 69 ± 7.9 years; 43% were female (36/83). Mean EuroScore II was 4.4 ± 3.8. 60%(50/83) of patients had received bilateral internal thoracic artery grafts (ITA) and 29% single ITA grafts (24/83). 7% underwent valve surgery and surgery of the ascending aorta. 54% (45/83) of the patients received a latissimus dorsi, 43% (36/83) a pectoralis muscle and 2% (2/83) a rectus abdominis flap. 46% of patients (38/83) developped wound infections after flap surgery. 27% showed necrosis of the used flap (22/83), requiring additional skin grafts in 19% (16/83). Repeat VacuSeal-therapy was needed in 31% (26/83). 12% (10/83) developped fistulas requiring revision. Mean total in-hospital stay was 82 ± 32 days. 30-day mortality was 13% (11/83).

Conclusion: The rate of complications after chest wall reconstruction using myocutaneous flaps is high. Repeat interventions were necessary in numerous cases. The need for prolonged total in- hospital stay due to repeat surgical interventions demonstrates a significant burden on health care and on patients. Myocutaneous flap surgery remains a challenge even after the initial procedure has been performed successfully.