A reconstructive algorithm for deep sternal wound coverage: the Cologne-Merheim approach

Background Several options are known for treatment of the sternal wounds. However, various wound diameters need various flaps. Patients and Methods 135 patients with sternum osteomyelitis from 2006 to 2010 of our institution were analyzed in a retrospective study. After using various flaps from 2006 to 2009 we developed an algorithm based on wound width, using pectoralis muscle flaps or the latissimus dorsi muscle flap. Two groups from 2006 - 2009, and 2010 were analyzed. A matched pair analysis was done for groups with small (< 6 cm), medium (6 cm - 12 cm) and large wound width (> 12 cm). Endpoint for each analysis was wound dehiscence larger than 1cm. Factors influencing wound dehiscence were analyzed, such as infectious agents, applied flap for coverage, gender, co-morbidities, number of debridements before closure, ICU length of stay. Statistical analysis was done by Mann Whitney U-Test using the SPSS program. Results 130 patients were included in the study and 48 in the match. No significant difference in patient population between the two groups was detected. Total number of wound dehiscence in the 2010 group was lesser, however without statistical significance. Groups with wound sizes lesser than 6 cm showed a significant difference in wound dehiscence when using our algorithm. However, significant lesser length of ICU and hospital stay for all groups treated according to our algorithm was seen. Conclusions ICU and hospital length of stay can be significantly reduced when using our algorithm, reducing costs for treatment of deep sternal osteomyelitis. Level of Evidence: Level IV, therapeutic study.