Abstract
ObjectiveThis study aims to report the use of the unilateral pectoralis major muscle flap for the treatment of the sternal wound dehiscence.MethodsA retrospective study including patients who underwent unilateral pectoralis major muscle flap was performed for the treatment of sternotomy dehiscence due to coronary artery bypass, valve replacement, congenital heart disease correction and mediastinitis, between 1997 and 2016. Data from the epidemiological profile of patients, length of hospital stay, postoperative complications and mortality rate were obtained.ResultsDuring this period, 11 patients had their dehiscence of sternotomy treated by unilateral pectoralis major muscle flap. The patients had a mean age of 54.7 years, the mean hospital stay after flap reconstruction was 17.9 days (from 7 to 52 days). In two patients, it was necessary to harvest a flap from the rectus abdominis fascia, in association with the pectoralis major muscle flap, to facilitate the closure of the distal wound. In the postoperative period, seroma discharge from the surgical wound was observed in six patients, five reported intense pain (temporary), three had partial cutaneous dehiscence, and two presented granuloma of the incision.ConclusionThe complex wound from sternotomy dehiscences presents itself as a challenge to surgical teams. Treatment should include debridement of necrotic tissue and preferably coverage with well-vascularized tissue. We propose that the unilateral pectoralis major muscle flap is an interesting and low morbidity option for the reconstruction of sternal wound dehiscences, with proper sternum stability and satisfactory functional and aesthetic outcomes.
Highlights
In the 1950s, Shumacker and Lurie[1] introduced the median sternotomy as an access route for cardiac surgery, including coronary artery bypass procedures[2]
During this period, 11 patients had their dehiscence of sternotomy treated by unilateral pectoralis major muscle flap
The complex wound from sternotomy dehiscences presents itself as a challenge to surgical teams
Summary
In the 1950s, Shumacker and Lurie[1] introduced the median sternotomy as an access route for cardiac surgery, including coronary artery bypass procedures[2]. Sternal wound dehiscence could often lead to major defects of the anterior chest wall, and it could expose the heart, vessels or any vascular prostheses and coronary grafts[3]. The resulting chest wall instability impairs respiratory function. Such patients commonly require prolonged mechanical ventilation, and experience a difficulty of the tissue healing[5]. Especially those resulting from infection, the transposition of vascularized tissues to the affected area greatly contributes to the stabilization of the chest wall, and to the ventilation dynamics, as well as to overcome the infection and to accelerate the healing[4].
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