Management of Sternal Wounds, Infections, and Sternal Non-Union with Plate Fixation: Result from a Single Site Experience.

Background: Patients with sternal wounds, infection, or non-union after cardiac surgery continue to have increased morbidity and mortality rates compared with those without sternal complications. Reconstructive methods have largely centered on soft tissue approaches, including muscle or omental flaps, which result in functional loss. Some data show early positive advantages using sternal rigid plate fixation (SRPF), however, it is debated in the setting of active infection. The goal of this study is to examine the outcomes of SRPF in patients with and without infections. Patients and Methods: This is a retrospective study of consecutive patients who underwent SRPF by a single plastic surgeon from April 2013 to August 2021. Patients treated without SRPF, lacking at least six months of follow-up, or those plated more than once were excluded. Ninety-seven patients were included. Demographic and peri-operative factors associated with sternal infection after SRPF were evaluated. Results: Sixty-eight patients were clinically infected/culture positive or open (INFECTED), and 29 were clean/primary plating (CLEAN). Sixteen percent of the INFECTED cases (11/68) returned with infection. Fourteen percent of the CLEAN cases (4/29) had subsequent infections. Additionally, we did note a decrease in rates of infections overall (p < 0.0001) as experience and frequency of plate fixation increased (p < 0.0001). Regardless of infection status, all but one patient had a healed and stable sternum at the end of data collection. Conclusions: There is no statistically significant difference between wound class prior to SRPF and development of infection after SRPF. Even in infected settings, patients can be treated successfully with SRPF. Further study is needed.

An alternative coverage for split thickness skin graft donor site wounds.

Diabetic foot and ankle soft tissue reconstruction poses a difficult challenge to the treating surgeon, especially in cases associated with previous infection or amputation. Maintenance of a functional, plantigrade limb is important with regard to prevention of persistent or recurrent cutaneous compromise following diabetic limb salvage. Wound coverage by means of application of a split thickness skin graft (STSG) is a useful technique; however, donor site wounds require care during the early postoperative period, and can pose a challenge to wound healing in and of themselves. In this article, we describe a technique of management of STSG donor site wounds that we have found to be useful and well tolerated by our patients.

An anatomical evaluation and surgical approach to the perioral mound in facial rejuvenation.

BACKGROUND: Premature aging of the perioral soft tissues of the face is a common complaint of patients seeking facial rejuvenation, although its cause is unclear. The subcutaneous fat compartments of the face may be differentially affected by facial aging. Despite efforts to study and rejuvenate the aging periorbit, midface, and jowls, the effects of aging on the perioral mound have been less studied. METHODS: To better understand the cause of age-associated changes in the perioral area, a cadaver dissection study was performed. Eight fresh and fixed cadavers with evidence of perioral fullness were used in anatomical dissection. Anatomical observations and histologic examination were used to describe the age-related changes in this area. After describing the defect, the authors present a surgical approach to rejuvenation of this region, tailored to the findings in this anatomical study. RESULTS: Histologic sections demonstrated a lipomatous area without defined ligamentous attachments or encapsulations. Chambers of adipocytes in the hypodermis were separated by thin fibroseptations: a scaffold in the structural support of this region. Superficial lipodystrophy defines thisfacial region in the cadaver specimens. The end result is a fatty, ptotic perioral mound of tissue that is not well addressed by conventional rhytidectomy. CONCLUSIONS: The area of the perioral mound may represent a small, independent fat compartment or a differentially affected extension of the nasolabial compartment described by Pessa. This cadaver study has increased the authors' understanding of the perioral region and allowed them to improve results in its rejuvenation. The senior author's preferred approach is liposculpture with fine-cannula liposuction.