Free Flaps in Sternal Osteomyelitis After Median Sternotomy: A Center's 12-Year Experience.

 Of a total of 165 patients included, 152 underwent DSWI defect reconstruction with a total of 12 different reconstruction methods. Although the defect size was larger in patients who underwent free flap coverage, and the risk profile in the fALT and FC flap groups was higher, the LOS after reconstruction (in days) did not differ significantly between the groups (pedicled vs. free flaps: 23 vs. 28,  > 0.05; pLD vs. fALT: 24.5 vs. 26,  > 0.05; MC vs. FC flaps: 23 vs. 26,  > 0.05). Also, no significant differences were found in terms of in-hospital mortality when comparing the groups (pedicled vs. free flaps: 11.2 vs. 17.4%,  > 0.05; pLD vs. fALT: 11.5 vs. 12.5%,  > 0.05; MC vs. FC flaps: 12.9 vs. 12.5%,  > 0.05) CONCLUSION:  With proper patient selection, free tissue transfer is a valuable alternative in the treatment of sternal dehiscence after a DSWI. Furthermore, our data demonstrate that MC flaps are not necessarily superior to FC flaps in the reconstruction of sternal osteomyelitis defects.