Therapeutic Outcomes of Pectoralis Major Muscle Turnover Flap in Mediastinitis

BACKGROUND: This study aimed to evaluate the therapeutic results and safety of pectoralis major muscle turnover flaps in the treatment of mediastinitis after coronary artery bypass grafting (CABG) procedures. METHODS: Data regarding 33 patients with post-CABG deep sternal wound infections (DSWIs) who underwent pectoralis major muscle turnover flap procedures in the Emam Reza and Ghaem Hospitals of Mashhad, Iran were reviewed in this study. For each patient, age, sex, hospital stay duration, remission, recurrence, and associated morbidity and mortality were evaluated. RESULTS: Of the 2,447 CABG procedures that were carried out during the time period encompassed by our study, DSWIs occurred in 61 patients (2.5%). Of these 61 patients, 33 patients (nine females [27.3%] and 24 males [72.7%]) with an average age of 63+/-4.54 years underwent pectoralis major muscle turnover flap placement. Symptoms of infection mainly occurred within the first 10 days after surgery (mean, 10.24+/-13.62 days). The most common risk factor for DSWIs was obesity (n=16, 48.4%) followed by diabetes mellitus (n=13, 39.4%). Bilateral and unilateral pectoralis major muscle turnover flaps were performed in 20 patients (60.6%) and 13 patients (39.4%), respectively. Complete remission was achieved in 25 patients (75.7%), with no recurrence in the follow-up period. Four patients (12.1%) needed reoperation. The mean hospitalization time was 11.69+/-6.516 days. Four patients (12.1%) died during the course of the study: three due to the postoperative complication of respiratory failure and one due to pulmonary thromboembolism. CONCLUSION: Pectoralis major muscle turnover flaps are an optimal technique in the treatment of post-CABG mediastinitis. In addition to leading to favorable therapeutic results, this flap is associated with minimal morbidity and mortality, as well as a short hospitalization time.

Risk factors associated with surgical site infection after breast surgery

Breast surgical site infection is not only one of the main causes of the morbidity and mortality of cases under different types of surgeries, but also it results in longer hospitalization and additional expenses. Identifying various potential parameters related to the occurrence of surgical site infection after the surgery and getting accurate knowledge about them can be beneficial in preventing the surgical site infection. Various types of studies have been conducted to evaluate the possible risk parameters of surgical site infection in every surgery. In this study, we tried to provide a brief review of the available literature regarding the risk factors associated with breast surgical site infection. To this end, we searched the Pubmed database for the relevant articles. We selected eight articles, which have studied the parameters with statistically significant association with the breast surgical site infection. According to our review, further studies with larger sample size can be effective in better evaluating the associated risk factors and presenting the exact effect of some uncertain risk factors of the surgical site infection after breast surgeries