Preface	5
	Table of content	6
	Editors	8
	Authors	9
	1Definition, Classification, and Epidemiology of Sternal Osteomyelitis	11
	Definition	12
	Classification	12
	Epidemiology and Economic Considerations	13
	2Anatomy and Blood Supply of the Sternum	16
	Bony Anatomy	17
	Relationship to Muscles	17
	Development	18
	Arterial Supply	19
	3Pathophysiology of Sternal Osteomyelitis	22
	Role of Bacteria	23
	Biofilm	23
	Caveats and Treatment Implications	24
	4Stabilization of Thoracic Wall and Ventilatory Function by Negative Pressure Wound Therapy	26
	Background	27
	Sternal Instability and Flail Chest	27
	Implications of Deep Sternal Wound Infections	27
	5Radiological Diagnostics of Postoperative Sternal Osteomyelitis	30
	Background	31
	Computed Tomography	31
	Radionuclide Imaging	32
	X-rays	33
	Magnetic Resonance Imaging	34
	6Microbiological Aspects and Epidemiological Data of Poststernotomy Deep Sternal Wound Infection	37
	Introduction	38
	Literature Search	38
	Results	38
	Frequency of DSWI	38
	Spectrum of Pathogens	40
	Conclusions for Clinical Practice	42
	7Primary Wound Management of Poststernotomy Infection	45
	Prevention	46
	Diagnosis	46
	Treatment	46
	How We Do It	47
	8Negative Pressure Wound Therapy in Poststernotomy Deep Sternal Wound Infection	49
	Introduction	51
	The Principle of NPWT	51
	Functional Principle	51
	Example of Application	51
	Effects on Wound Healing	52
	Handling and Duration of Application	54
	Literature Overview	54
	Literature Search and Selection Method	54
	Results	55
	Aspects of Evidence-Based Medicine	56
	Science Behind NPWT in DSWI	60
	NPWT-Induced Change in Perfusion	60
	Effects of Different Suction Strengths on Wound Sealing	69
	Decontamination, Bacterial Clearance, and Immunological Effects of NPWT	69
	Molecular Mechanisms in Wound Healing with NPWT	71
	Microdeformational Effects of NPWT	72
	Effect on Topical Antibiotic Concentrations	74
	Technical Aspects of NPWT in Treatment of DSWI	74
	Selection of Foam Material	74
	Selection of Suction Strength	74
	Selection of Vacuum Source	75
	Complications of NPWT in DSWI	75
	Contraindications	76
	Conclusions for Clinical Practice	76
	9Bone Stabilization Methods After Sternal Osteotomy	82
	Introduction	83
	Standard Technique of Sternal Osteosynthesis	83
	Different Sternal Closure Techniques	84
	Sternal Osteosynthesis Under Special Conditions	84
	Sternal Osteosynthesis in Neonates and Infants	86
	10Principles of Plastic Surgery in Sternal Osteomyelitis	89
	Introduction	90
	Involvement of the Plastic Surgeon	90
	Principles of Regional Flaps Versus Free Flaps	90
	Managing the Microbiobial Burden of Sternal Wounds During Defect Coverage	92
	Principles of Plastic Surgical Management	92
	Preventive Plastic Surgery in High-Risk Patients (Flap Delay)	93
	11Plastic Surgical Methods of Defect Coverage in Sternal Osteomyelitis with Pedicled Flaps	96
	Introduction	97
	Pectoralis Major Flap	98
	Rectus Abdominis Flap	99
	Latissimus Dorsi Flap	101
	Greater Omentum Flap	103
	Conclusion	104
	12Indications for Free Flap Coverage and Interdisciplinary Combined Approaches with Vascular Surgery AV Loops	106
	Introduction	107
	Indications for Free Flap Reconstruction	107
	Surgical Procedure of Free Flap Transplantation and Combined Approaches	108
	Conclusion	112
	13Anesthesiological Management	114
	Introduction	115
	Anesthesiological Management of DSWI	115
	Basic Monitoring	116
	Advanced Monitoring	116
	Echocardiography	117
	Anesthetic Considerations and Intraoperative Management	117
	14Rehabilitation After Sternal Osteomyelitis	119
	15Prevention of Poststernotomy Wound Infections by Closed Incision Negative Pressure Therapy	122
	Introduction	123
	Literature Review: The Randomized Trials	123
	Clinical Experiences With ciNPT	129
	How Does the Cost–Benefit Analysis Look?	131
	Can Evidence-Based Recommendations Be Formulated for ciNPT Use?	131
	Patient-Related Risk Factors in Sternotomy	131
	Operation-Related Risk Factors	132
	Conclusion	133
	Servicepart	137
	Index	138