256. Vacuum-Assist Wound Closure Versus Bilateral Pectoralis Major Muscle Flaps for Deep Sternal Wound Infection in Adult Patients After Cardiovascular Surgery
Tuo Pan1, Chengbin Tang1, Yongshun Gao2, Dongjin Wang1
1Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China;2 Seventh Medical Center of People’s Liberation Army General Hospital, Beijing, China
Objective: The aim of this study was to prospectively evaluate the results of reconstructing infected post-sternotomy wound, with either vacuum-assisted closure (VAC) after previous debridement or bilateral pectoralis major muscle flaps (BPMMF).
Methods: In total, 565 patients with postoperative deep sternal wound infection (DSWI) were enrolled in this study from January 1st, 2014 to June 1st, 2018. Of these patients, 247 received BPMMF. To address indicated biases, a 1:1 matched cohort was created based on age, body mass index, preoperative diabetes mellitus, surgical type and wound classification. After matching, 110 patients who had similar risk profile were enrolled in study population (55 VAC group: 55 BPMMF group).
Results: At 21.31±13.14 (median: 24, IQR: 13-24) months of follow-up, survival was 90.91% in BPMMF group and 60% in VAC group. Compared with VAC group, BPMMF group significantly decreased mechanical ventilation time (P=0.001) and length of hospital stay (P<0.001). At spirometry assessment, forced expiratory volume in the 1st second (FEV1), vital capacity (VC), and FEV1/VC ratio had no significant differences in survivals between VAC group and BPMMF group.
Conclusions: In our study, compared with VAC, the BPMMF guaranteed better early and late term outcomes as shown by less mechanical ventilation time and lower rate of mortality and impaired respiratory function. These results suggest that, BPMMF is an effective surgical treatment for DSWI, VAC may be considered as adjuvant therapy in patient with DSWI.
Postoperative complications after therapies
FEV1 in survivals (L)
VC in survivals (L)
FEV1/VC in survivals (%)
Mechanical ventilation time (hours)
ICU stay time (days)
Length of hospital stay (days)
Death in hospital (n, %)
Survival (n, %)
Recurrence of DSWI or failed in treatment of DSWI (n, %)