Molenkamp, S. (2013) Reconstruction of the sternum using the pectoralis major muscle in patients with sternal dehiscence caused by mediastinitis. thesis, Medicine.
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Abstract
Objective: Mediastinitis followed by sternal dehiscence is a devastating complication in open heart surgery, often requiring additional surgery, with - as first step - extensive debridement. The resulting defect frequently necessitates reconstruction of the sternum. Since the introduction of muscle flaps and greater omentum flaps, morbidity and mortality have been significantly reduced. Nevertheless the postoperative complication incidence is still high. In this study postoperative outcome and individual characteristics of patients undergoing pectoralis major flap repair were analyzed in an effort to identify predictors of postoperative complications. Methods: A retrospective study was conducted, covering the period January 2006 to December 2012, in which multiple patient- and operation characteristics were analyzed by reviewing the medical charts. All patients who received pectoralis major flap reconstruction of the sternum were included. All postoperative complications were listed and graded according to the Clavien-Dindo classification of surgical complications. Complications were further divided in major and minor. Pearson’s X2 test, Fisher’s exact test and a multivariable logistic regression were used for data analysis. IBM SPSS statistics version 20.0 (New York, USA) was used as analysis engine. Significance was set at P ≤ 0.05. Results: In total, 77 patients underwent 151 pectoralis major advancement flap repairs. Fifty-six patients (73%) developed a postoperative complication, of these patients 28 complications (36%) were classified as major. Thirty-eight patients (49%) developed a surgical-site complication of which 21 (27%) had a major complication at the surgical site. Seven patients (9%) died within 30 days after operation or during hospital admission. In this study, age was a predicting factor of postoperative complications. Current smokers significantly experienced more (major) wound complications. Operative time was also longer in patients who developed complications at the surgical site. Women and patients in whom it was difficult to close the most caudal part of the sternum were more likely to develop wound re-dehiscence and patients in whom the humeral insertion of the pectoralis major flap was divided experienced more postoperative bleeding for which surgical revision was demanded. Postoperative hospital stay was significantly longer in patients who developed a postoperative complication. Conclusions: Reconstruction of the sternum using pectoralis major advancement flaps is a procedure that is still hampered by a high postoperative complication incidence. Comparing our numbers with the literature was made difficult due to inconsistency in classification of complications, but the incidence seemed fairly high. A relation was found with age, gender, smoking, difficulty closing the caudal part of the sternum, detachment of the humeral insertion and operative time. The results of this study may contribute in improving operative strategy and anticipation of outcomes. Also they lay the foundation for a more in-depth prospective study.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Werker, Prof. Dr. P.M.N. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:45 |
| Last Modified: | 25 Jun 2020 10:45 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/665 |
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