Pectoralis major muscle transposition for treatment of infected median sternotomy wounds

Abstract

Median sternotomy, currently the standard incision in open heart procedures, is rarely complicated by wound infection, but when present, it is associated with a high morbidity and mortality. Adequate treatment can be provided by means of transposition of the pectoralis major muscle. After thorough sternal wound debridement the muscle, based on the thoraco-acromial pedicle, is transposed into the defect. From September 1986 until December 1992 14 patients (mean age 67 years) with sternal infection were treated using this technique. Mean hospital stay after operation was 23 days; mean follow-up was 24 months. In 10 patients (72%) a successful treatment, i.e. a permanently cured infection, was achieved. Three patients (21%) developed a recurrence; one of them died during follow-up as a consequence of cardiac failure, the other two underwent reoperation and healing occurred at a later stage. In one patient (who died of a unknown cause 2 months after muscle transposition) the result was classified as unknown. In conclusion, transposition of the pectoralis major muscle is an adequate treatment for severe sternal infections. In comparison with conservative methods, mortality and morbidity can be reduced and hospital stay can be shortened.