Immediate flap increases patient safety for deep sternal wound infection: A meta‐analysis

Deep sternal wound infection is a severe complication after cardiac surgery. We performed a meta‐analysis evaluating the impact of immediate flap and NPWT on mortality and length of hospital stay. The meta‐analysis was registered (CRD42022351755). A systematic literature search was conducted from inception to January, 2023, including PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov and EU Clinical Trials Register. The main outcome were in‐hospital mortality and late mortality. And additional outcomes were length of stay and ICU stay time. A total of 438 patients (Immediate flap: 229; NPWT: 209) from four studies were included in this study. Immediate flap was associated with lower in‐hospital mortality (OR 0.33, 95% CI 0.13‐0.81, P = .02) and length of stay (SMD −13.24, 95% CI −20.53 to −5.94, P = .0004). Moreover, pooled analysis demonstrated no significant difference was found in two groups in terms of late mortality (OR 0.64, 95% CI 0.35‐1.16, P = .14) and ICU stay time (SMD −1.65, 95% CI −4.13 to 0.83, P = .19). Immediate flap could reduce in‐hospital mortality and length of stay for patients with deep sternal wound infection. Flap transplantation as soon as possible may be advised.