The use of flaps for management of deep sternal wound complications: A systematic review and meta-analysis

Background: Many options are available for reconstruction after deep sternal wound infections. However, these options have not been critically appraised. The aim of this systematic review and meta -analysis was to assess the existing evidence on sternal rewiring versus flap re - construction and pectoralis major muscle flaps (PMFs ) versus greater omental flaps (GOFs ). Methods: A systematic review and meta -analysis was performed. CENTRAL, MEDLINE and EMBASE were searched. Outcomes of interest included mortality, treatment failure and length of hospital stay (LOS ). Results: Fourteen studies were included. Nine studies compared flaps to rewiring, reporting on 618 patients. Patients treated with flaps had significantly lower mortality compared with pa - tient treated with rewiring (Risk ratio [RR ] 0.42, 95% confidence interval [CI ]: 0.23-0.77, P < 0.01 ). Flap patients had significantly lower treatment failure compared with those who were treated with rewiring (RR 0.22, 95% CI: 0.14-0.37, P < 0.01 ). No statistically significant differences were observed in LOS between patients treated with flaps compared those treated with rewiring (standard mean difference -0.84, 95% CI: -1.91 to 0.24, P = 0.13 ). Five studies compared PMF with GOF, reporting on 599 patients. No statistically significant differences were found in mortality (RR 0.63, 95% CI: 0.24-1.68, P = 0.36 ), LOS (standard mean difference -14.52, 95% CI: -42.00 to 12.96, P = 0.30 ) or treatment failure (RR 1.37, 95% CI: 0.31-6.07, P = 0.68 ) in patients treated with PMF compared with patients treated with GOF. Conclusions: Flap -based reconstruction demonstrated improved mortality and treatment out - comes compared to sternal rewiring. However, no significant differences were observed in outcomes between the PMF - and GOF -based reconstructions. (c) 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.