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A new classification of post-sternotomy dehiscence.

Anger J, Dantas DC, Arnoni RT, Farsky PS - Rev Bras Cir Cardiovasc (2015 Jan-Mar)

Bottom Line: The dehiscence after median transesternal sternotomy used as surgical access for cardiac surgery is one of its complications and it increases the patient's morbidity and mortality.A variety of surgical techniques were recently described resulting to the need of a classification bringing a measure of objectivity to the management of these complex and dangerous wounds.The different related classifications are based in the primary causal infection, but recently the anatomical description of the wound including the deepness and the vertical extension showed to be more useful.

View Article: PubMed Central - PubMed

Affiliation: Dante Pazzanese Institute of Cardiology of São Paulo, São Paulo, SP, Brazil.

ABSTRACT
The dehiscence after median transesternal sternotomy used as surgical access for cardiac surgery is one of its complications and it increases the patient's morbidity and mortality. A variety of surgical techniques were recently described resulting to the need of a classification bringing a measure of objectivity to the management of these complex and dangerous wounds. The different related classifications are based in the primary causal infection, but recently the anatomical description of the wound including the deepness and the vertical extension showed to be more useful. We propose a new classification based only on the anatomical changes following sternotomy dehiscence and chronic wound formation separating it in four types according to the deepness and in two sub-groups according to the vertical extension based on the inferior insertion of the pectoralis major muscle.

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Male patient, 60 years of age with post-CABG dehiscence in the37th postoperative day, treated with fasciocutaneous flap ofbilateral pectoralis major muscle
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f01: Male patient, 60 years of age with post-CABG dehiscence in the37th postoperative day, treated with fasciocutaneous flap ofbilateral pectoralis major muscle

Mentions: Consequently, we created a uniquely classification based on the depth and anatomicalextent of the wounds which seemed to us to be more complete and objective.Initially, we divided the surgical wound into four types, according to the depthaffected: type I, when there is loss of skin and subcutaneous tissue; type II, whenthe bone is exposed; type III, when there is loss of bone tissue of sternum or ribs;type IV and when there is exposure of the mediastinum (Table 5). Next, we define whether it is partial or total inrelation to its vertical extent and in the end whether it is of higher or lowerposition, considering as reference the inclusion of the lower margin of thepectoralis major muscle. To illustrate the use of this classification we presentthree examples of patients with chronic wounds in which different surgicaltechniques have been adopted based on anatomical changes of the surgical wound(Figures 1A, 1B, 2A, 2B, 3A,3B). The result of the classificationproposed in these cases was more precise and specific than if we used theclassification methods previously used.


A new classification of post-sternotomy dehiscence.

Anger J, Dantas DC, Arnoni RT, Farsky PS - Rev Bras Cir Cardiovasc (2015 Jan-Mar)

Male patient, 60 years of age with post-CABG dehiscence in the37th postoperative day, treated with fasciocutaneous flap ofbilateral pectoralis major muscle
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4389524&req=5

f01: Male patient, 60 years of age with post-CABG dehiscence in the37th postoperative day, treated with fasciocutaneous flap ofbilateral pectoralis major muscle
Mentions: Consequently, we created a uniquely classification based on the depth and anatomicalextent of the wounds which seemed to us to be more complete and objective.Initially, we divided the surgical wound into four types, according to the depthaffected: type I, when there is loss of skin and subcutaneous tissue; type II, whenthe bone is exposed; type III, when there is loss of bone tissue of sternum or ribs;type IV and when there is exposure of the mediastinum (Table 5). Next, we define whether it is partial or total inrelation to its vertical extent and in the end whether it is of higher or lowerposition, considering as reference the inclusion of the lower margin of thepectoralis major muscle. To illustrate the use of this classification we presentthree examples of patients with chronic wounds in which different surgicaltechniques have been adopted based on anatomical changes of the surgical wound(Figures 1A, 1B, 2A, 2B, 3A,3B). The result of the classificationproposed in these cases was more precise and specific than if we used theclassification methods previously used.

Bottom Line: The dehiscence after median transesternal sternotomy used as surgical access for cardiac surgery is one of its complications and it increases the patient's morbidity and mortality.A variety of surgical techniques were recently described resulting to the need of a classification bringing a measure of objectivity to the management of these complex and dangerous wounds.The different related classifications are based in the primary causal infection, but recently the anatomical description of the wound including the deepness and the vertical extension showed to be more useful.

View Article: PubMed Central - PubMed

Affiliation: Dante Pazzanese Institute of Cardiology of São Paulo, São Paulo, SP, Brazil.

ABSTRACT
The dehiscence after median transesternal sternotomy used as surgical access for cardiac surgery is one of its complications and it increases the patient's morbidity and mortality. A variety of surgical techniques were recently described resulting to the need of a classification bringing a measure of objectivity to the management of these complex and dangerous wounds. The different related classifications are based in the primary causal infection, but recently the anatomical description of the wound including the deepness and the vertical extension showed to be more useful. We propose a new classification based only on the anatomical changes following sternotomy dehiscence and chronic wound formation separating it in four types according to the deepness and in two sub-groups according to the vertical extension based on the inferior insertion of the pectoralis major muscle.

Show MeSH
Related in: MedlinePlus