Optimal Timing of Multidisciplinary Management of Sternal Wound Complications.

BACKGROUND

Sternal wound complications after median sternotomy increase morbidity and mortality, and plastic and reconstructive surgery is often consulted to provide closure with flap reconstruction. In this study, we investigated how the timing of plastic surgery involvement may influence outcomes in this setting.

METHODS

We performed a retrospective review of patients with sternal wound complications cared for at our institution during a 10-year period. Patients were stratified into quartiles based on time from detected complication to plastic surgery consultation. Primary outcome variables included morbidity (postoperative complications and reoperation) and all-cause mortality at 1 year. Univariable followed by multivariable logistic regression was performed to characterize risk factors for these adverse outcomes.

RESULTS

A total of 188 patients composed the study population. The time to plastic surgery consultation quartiles were as follows: immediate, 0 to 1 days (n = 46); early, 2 to 5 days (n = 50); delayed, 6 to 14 days (n = 42); and late, >14 days (n = 50). Patient demographics, comorbidities, and reconstructive characteristics did not differ across groups. Increased time to plastic surgery consultation was associated with sternal wound reoperations ( = .026), 1-year mortality ( = .008), hematoma ( = .044), and sternal dehiscence recurrence ( = .019). Multivariable regression demonstrated that increased time to plastic surgery consultation was associated with increased sternal wound reoperations (odds ratio [OR], 1.1;  = .041), sternal wound recurrence (OR, 1.5;  = .018), and mortality (OR, 1.3;  = .037).

CONCLUSIONS

Early involvement of plastic surgery in treating sternal wounds is significantly associated with a reduction in mortality, recurrence of sternal dehiscence, and reoperation. Successful treatment of these challenging complications requires multidisciplinary collaboration, and prompt plastic surgery consultation is recommended.