An Alternative Technique for Surgical Management of Poststernotomy Osteomyelitis and Reconstruction of the Sternal Defect

Petros Konofaos,Eleftherios Spartalis,Periklis Tomos,Grigorios Karagkiouzis,Christos Kampolis

doi:10.1155/2013/451594

Petros Konofaos, Eleftherios Spartalis + Show 3 more

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https://doi.org/10.1155/2013/451594

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Abstract

Introduction. Sternal osteomyelitis with or without mediastinal infection is a severe and rare complication of median sternotomy. In this paper, an alternative technique for the reconstruction of sternal defects with the use of bilateral pectoralis major pedicled muscle flaps is presented. Case presentation. A 70-year-old man with the diagnosis of poststernotomy osteomyelitis underwent reconstruction of his sternal defect with the use of bilateral pectoralis major muscle flaps. The patient had an uneventful recovery, and the physical examination revealed a normal range of motion for both upper limbs and sternal stability. Conclusion. The proposed technique incorporates a simple mobilization of the two pectoralis major muscles to be used as flaps to fill the sternal defect without the need for humeral detachment or a second cutaneous incision. Using this technique, a muscular implant is made that seals the dead space, which has no tension due to the presence of a second layer. Postoperative results are excellent, not only regarding infection and functionality but also from an aesthetic point of view.

Highlights

Sternal osteomyelitis with or without mediastinal infection is a severe and rare complication of median sternotomy
We evaluate the postoperative results of the use of the bilateral pectoralis major pedicled muscle flap with the use of an alternative technique for reconstruction of sternal defects
The goals of the treatment of postoperative sternal osteomyelitis and mediastinitis are to resolve the infectious process in the shortest time possible, ensure sternal stability, and provide the best possible cosmetic results

Summary

Introduction

Poststernotomy infection due to coronary artery bypass grafting represents one of the greatest challenges for the reconstructive surgeon. Its incidence is ranged between 1% and 4% [1, 2]. Mainstay of the reconstruction of sternal defects is to provide long term and stable coverage of thoracic viscera without marked patient morbidity. Many authors have described the use of other muscles as flaps [3, 4]. We evaluate the postoperative results of the use of the bilateral pectoralis major pedicled muscle flap with the use of an alternative technique for reconstruction of sternal defects

Case Presentation

Discussion

Conclusions

Conflict of Interests