Predictors of mortality after muscle flap advancement for deep sternal wound infections.

BACKGROUND: Deep sternal wound infection is a devastating complication following median sternotomy, with mortality rates reported from 1.0 to 36 percent. Several studies have evaluated the risk factors for the development of a deep sternal wound infection, but the factors predicting survival after debridement and muscle flap advancement are not well known. METHODS: A retrospective chart review was performed from September of 1997 to January of 2004 on all patients referred to a single plastic surgeon for treatment of a deep sternal wound infection following median sternotomy for cardiovascular surgery. The authors collected cardiovascular operative and intensive care unit data and information regarding patient demographics, medical history, laboratory studies, and follow-up. Data were analyzed as possible prognostic factors. RESULTS: During the collection period, a total of 8414 cardiovascular surgery cases were performed through a median sternotomy. Deep sternal wound infections were identified and treated with muscle flap advancement in 124 patients (1.5 percent). Most patients (90 percent) were treated with bilateral pectoralis major flap advancements. Eighty-five patients underwent debridement and muscle flap advancement as a single-stage procedure. There were 26 perioperative deaths (21 percent). Presternotomy end-stage renal disease, presternotomy chronic obstructive pulmonary disease, and prolonged poststernotomy mechanical ventilation were found to be significant independent predictors of mortality despite muscle flap advancement. CONCLUSIONS: These data identify patients with deep sternal wound infections who may be at increased risk for mortality after debridement and muscle flap advancement. This information may help the patient, family, and surgeon modify medical management or surgical treatment of this devastating problem.

Lysyl oxidase expression in bronchogenic carcinoma.

BACKGROUND: Lysyl oxidase catalyzes a key step in the cross-linking of collagen and elastin in the extracellular matrix. Recent studies have documented differential lysyl oxidase expression in the stromal reaction to colon, breast, prostate, and lung cancer. The present study was undertaken to test the hypothesis that lysyl oxidase mRNA and protein expression decrease with advancing tumor stage in patients with bronchogenic carcinoma. METHODS: Tumor specimens were obtained from 17 patients undergoing resection for bronchogenic carcinoma. Real-time polymerase chain reaction was used to determine steady-state lysyl oxidase mRNA expression, and protein expression was qualitatively assessed by immunohistochemistry. RESULTS: Real-time polymerase chain reaction studies documented a 3.4-fold graded decrease in lysyl oxidase mRNA levels as tumors progressed from stage I to IV. Similar qualitative changes in lysyl oxidase protein expression were demonstrated by immunohistochemistry. CONCLUSIONS: These results support the hypothesis that variations in lysyl oxidase expression may correlate with the invasive and metastatic potential of bronchogenic carcinoma.