Successful Management of Sternomanubrial Joint Septic Arthritis with Pectoralis Muscle Flap Closure
Barkat Ali, MD, Anil Shetty, MD, Gregory Borah, MD, Christorpher Demas, MD, Jess D. Schwartz, MD.
University of New Mexico, Albuquerque, NM, USA.
Objective: Primary infection of the sternomanubrial joint (SMJ) is extremely rare. With only 13 individual case reports in the adult literature, treatment strategies remain controversial. Our institution has adopted an aggressive surgical approach of SMJ resection combined with pectoralis muscle flap closure (PMFC). We sought to characterize the current presentation of this disease and our experience with this approach in the management of this condition.
Methods: This is a retrospective study of 4 consecutive patients diagnosed with SMJ infections from July 2005 to June 2019. All 4 patients were treated with SMJ resection (partial sternectomy), bilateral partial 2nd rib resection and immediate placement of temporary wound vacuum therapy. At initial wound vacuum change the wound was evaluate for readiness of PMFC. Patient demographics, diagnostic imaging studies, microbiology, recurrence of infection, perioperative morbidity and mortality were examined.
Results: Average patient age was 35.5 years with male predominance (75%), with all presenting with local symptoms of pain and swelling. All patients had intravenous drug use as underlying risk factor along with concomitant viral infections Hep C (75%) and HIV (25%). MSSA was identified in resection cultures in 75% of the patients. Delayed bilateral PMFC was achieved in all patients (average post-resection day 5). Response to treatment was excellent with no recurrent infections, no complications, and zero 30-day mortalities.
Conclusion: Our experience represents the largest reported case series in adults and would suggest aggressive surgical resection followed by PMFC would appear to be the preferred treatment for all patients with SMJ infection.
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