gms | German Medical Science

Background: Sternal osteomyelitis is with up to 8 % a frequent and due to high mortality rates a severe complication after thoracic and cardiac surgery. Therapy strategies based on superficial surgical debridement in combination with antibiotics do not seem to be effective. The subtotal or partial sternectomy followed by reconstruction of the chest wall with an autologous muscle flap is the gold standard for infection treatment in plastic and reconstructive surgery. However, patients as well as thoracic and cardiac surgeons are often concerned about the radical approach and the possible impairment of the lung function and the quality of life. There are no data on the effect of a sternectomy on lung function and quality of life. To evaluate the impact of a subtotal or partial sternectomy, we compared pre- and postinterventional pulmonary function parameters and evaluated the effects on the QOL (quality of life).

Materials and methods: After approval of the local committee of medical ethics and written informed consent we enrolled patients who underwent subtotal or partial sternectomy due to sternal osteomyelitis and received an autologous muscle flap. At the time of hospital admission and after reconstruction of the chest wall the forced expiratory volume in one second (FEV1), the vital and total capacity (VLC/TLC) and the stress on inspiration muscles (p01) were measured. In addition, the QOL was evaluated using a questionnaire with six dimensions. The pre- and postinterventional findings were compared using a paired t-test (p < 0.05).

Results: 28 women and 22 men (66.8 ± 11 years) with sternal osteomyelitis after aortic valve replacement (n = 14) and after isolated coronary bypass artery grafts (n = 36) were examined. In 64 % of patients the left and in 12 % the right internal thoracic artery was used as bypass material. 68 % underwent a subtotal sternectomy and 32 % a partial sternectomy. In more than half (64 %) of the patients, the chest wall was reconstructed by using the right or left M. pectoralis major (vascular-pedicled), in 24 % by using both of the Mm. pectorales majores and in 12 % defect coverage was achieved by using a M. latissimus dorsi muscle - flap (vascular-pedicled). The complete infection removal and reconstruction of the chest wall was achieved with an average of five operations during a length of stay in our departement of 42.6 ± 22.8 days.

Conclusion: The partial or subtotal sternectomy accompanied by an autologous muscle flap for reconstruction of the chest wall is therefore still the gold standard for an effective infection treatment of sternal osteomyelitis as it has no negative effect on the lung function and improves the quality of life of patients.