Plastic Surgery’s role in the treatment of complex wounds - Sternotomy infection with CR-Kp: case report.

Abstract

Introduction. One of the main goals of the Plastic Surgery Academic League is to demystify the speciality among medical students, showing that its acting field goes beyond the patient’s aesthetics. The reconstructive surgery is one of the main pillars in Plastic Surgery and aims to re-establish functionality and aesthetics. Reconstructive surgery is often applied to the treatment of complex wounds, contributing significantly in decreasing the patient’s morbimortality and improving its standard of living. The thorax is a danger zone when it becomes infected and a sternotomy infection can evolve quickly to a devastating mediastinitis. Case Report: 60-year-old man, with arterial hypertension, former smoker and former alcoholic was submitted to elective coronary artery bypass graft in 2015, and during the 14th post-op evolved with surgical wound hyperemia; wide antiobiotic therapy was initiated, with no clinical improvement. As part of the hospital protocol, the Plastic Surgery team was called to evaluate the patient and then indicated surgical approach, which was done with wide debridement and negative pressure wound therapy. A sternal fragment culture identified colistine resistant Klebsiella pneumoniae, a bacteria that requires very complex treatment. After three surgical approaches, with two changes of negative pressure wound therapy (NPWT) and wide antibiotic therapy, the patient had a favourable outcome. Discussion and Conclusion. The treatment of infected surgical wounds goes beyond wide antibiotic therapy; surgical approach with wide debridement is mandatory, but even the debridement alone is not enough and closing an infected wound can have disastrous consequences. NPWT allowed a great revolution in complex wounds treatment, because it creates a sufficiently dry environment which hampers bacteria growth and enhances local healing as a whole. Treating complex wounds is a great example of action in Plastic Surgery field that goes beyond aesthetical concern – it has a wide role in decreasing mortality and morbidity for the patients.