Deep sternal wound infection after open heart surgery – reconstructive options

Figures & data

Figure 1. Flowchart of the search strategy.

Table I. The level of evidence of included studies.*

Level of evidence	Description	No. (%)
I	Randomized controlled trials	0 (0)
II	Cohort studies, outcomes research	6 (3)
III	Individual case-control studies	26 (12)
IV	Case-series/case-report	181 (82)
V	Expert opinion, experimental studies	7 (3)
Total		220**

*The level of evidence classification in this table is a modification of the original Oxford levels of Evidence Scale.

**Four studies were not applicable for evidence level grading.

Table II. Included articles and their main outcome measure.

Main outcome	Specified outcome measure	No.	Evidence level range
Surgical methods	Pectoralis major flap	27	III–IV
	Rectus abdominis flap	10	IV
	Omental flap	29	III–IV
	Latissimus dorsi flap	4	IV
	Focus on more than one type of flap	17	III–IV
	Metal plates, screws and cables	10	IV–V
	Pectoralis major flap combined with omental flap	3	IV
	Pectoralis major flap combined with Rectus abdominis flap	7	IV
	Omental flap versus pectoralis major flap	2	III
	Rectus abdominis flap versus pectoralis major flap	1	III
Comparison of methods	Pectoralis major flap versus TNP therapy	1	III
	Immediate versus delayed wound closure	1	III
	TNP therapy versus conventional primary wound care	6	III
	Open wound treatment versus muscle flap closure	2	III
	TNP versus primary rewiring	1	III
Topical negative pressure	TNP therapy as an adjunct to flap surgery	32	IV
	TNP therapy as sole treatment	2	IV
	Risk factors	34	II–IV
Statistics	Mortality	10	II–IV
	Morbidity	10	II–IV
Other	Advanced antibiotics, classifications, experimental studies, proposed studies etc.	15	III–IV*

TNP = topical negative pressure.

*Four studies in this group were not applicable for evidence level grading.