This concise and practical handbook covers the basics of pathophysiology, diagnosis, interdisciplinary surgical management, prevention and rehabilitation of patients with deep sternal wound infections and sternal osteomyelitis.

All relevant aspects and surgical procedures are explained in an easily understandable way. Additionally special approaches and preventive measures are highlighted with regard to the perioperative handling as well as the rehabilitation possibilities.

This book is suitable for all specialists who are involved into the treatment and diagnosis

of sternal wound infections, particularly cardio-thoracis, thoracic, plastic, vascular

surgeons, cardiologists, radiologists, and rehabilitation physicians.

1;Preface;5 2;Table of content;6 3;Editors;8 4;Authors;9 5;1Definition, Classification, and Epidemiology of Sternal Osteomyelitis;11 5.1;Definition;12 5.2;Classification;12 5.3;Epidemiology and Economic Considerations;13 6;2Anatomy and Blood Supply of the Sternum;16 6.1;Bony Anatomy;17 6.2;Relationship to Muscles;17 6.3;Development;18 6.4;Arterial Supply;19 7;3Pathophysiology of Sternal Osteomyelitis;22 7.1;Role of Bacteria;23 7.2;Biofilm;23 7.3;Caveats and Treatment Implications;24 8;4Stabilization of Thoracic Wall and Ventilatory Function by Negative Pressure Wound Therapy;26 8.1;Background;27 8.2;Sternal Instability and Flail Chest;27 8.3;Implications of Deep Sternal Wound Infections;27 9;5Radiological Diagnostics of Postoperative Sternal Osteomyelitis;30 9.1;Background;31 9.2;Computed Tomography;31 9.3;Radionuclide Imaging;32 9.4;X-rays;33 9.5;Magnetic Resonance Imaging;34 10;6Microbiological Aspects and Epidemiological Data of Poststernotomy Deep Sternal Wound Infection;37 10.1;Introduction;38 10.2;Literature Search;38 10.3;Results;38 10.3.1;Frequency of DSWI;38 10.3.2;Spectrum of Pathogens;40 10.4;Conclusions for Clinical Practice;42 11;7Primary Wound Management of Poststernotomy Infection;45 11.1;Prevention;46 11.2;Diagnosis;46 11.3;Treatment;46 11.4;How We Do It;47 12;8Negative Pressure Wound Therapy in Poststernotomy Deep Sternal Wound Infection;49 12.1;Introduction;51 12.2;The Principle of NPWT;51 12.2.1;Functional Principle;51 12.2.2;Example of Application;51 12.2.3;Effects on Wound Healing;52 12.2.4;Handling and Duration of Application;54 12.3;Literature Overview;54 12.3.1;Literature Search and Selection Method;54 12.3.2;Results;55 12.3.3;Aspects of Evidence-Based Medicine;56 12.4;Science Behind NPWT in DSWI;60 12.4.1;NPWT-Induced Change in Perfusion;60 12.4.2;Effects of Different Suction Strengths on Wound Sealing;69 12.4.3;Decontamination, Bacterial Clearance, and Immunological Effects of NPWT;69 12.4.4;Molecular Mechanisms in Wound Healing with NPWT;71 12.4.5;Microdeformational Effects of NPWT;72 12.4.6;Effect on Topical Antibiotic Concentrations;74 12.5;Technical Aspects of NPWT in Treatment of DSWI;74 12.5.1;Selection of Foam Material;74 12.5.2;Selection of Suction Strength;74 12.5.3;Selection of Vacuum Source;75 12.5.4;Complications of NPWT in DSWI;75 12.5.5;Contraindications;76 12.6;Conclusions for Clinical Practice;76 13;9Bone Stabilization Methods After Sternal Osteotomy;82 13.1;Introduction;83 13.2;Standard Technique of Sternal Osteosynthesis;83 13.3;Different Sternal Closure Techniques;84 13.4;Sternal Osteosynthesis Under Special Conditions;84 13.5;Sternal Osteosynthesis in Neonates and Infants;86 14;10Principles of Plastic Surgery in Sternal Osteomyelitis;89 14.1;Introduction;90 14.2;Involvement of the Plastic Surgeon;90 14.3;Principles of Regional Flaps Versus Free Flaps;90 14.4;Managing the Microbiobial Burden of Sternal Wounds During Defect Coverage;92 14.5;Principles of Plastic Surgical Management;92 14.6;Preventive Plastic Surgery in High-Risk Patients (Flap Delay);93 15;11Plastic Surgical Methods of Defect Coverage in Sternal Osteomyelitis with Pedicled Flaps;96 15.1;Introduction;97 15.2;Pectoralis Major Flap;98 15.3;Rectus Abdominis Flap;99 15.4;Latissimus Dorsi Flap;101 15.5;Greater Omentum Flap;103 15.6;Conclusion;104 16;12Indications for Free Flap Coverage and Interdisciplinary Combined Approaches with Vascular Surgery AV Loops;106 16.1;Introduction;107 16.2;Indications for Free Flap Reconstruction;107 16.3;Surgical Procedure of Free Flap Transplantation and Combined Approaches;108 16.4;Conclusion;112 17;13Anesthesiological Management;114 17.1;Introduction;115 17.2;Anesthesiological Management of DSWI;115 17.2.1;Basic Monitoring;116 17.2.2;Advanced Monitoring;116 17.2.3;Echocardiography;117 17.2.4;Anesthetic Considerations and Intraoperative Management;117 18;14Rehabilitation After Sternal Osteomyelitis;119 19;15Prevention of Poststernotomy Wound Infections by Closed Incision Negative Pressure