Pectoralis Major Musculocutaneous Flaps—An Effective Tool in the Cardiothoracic Surgeon's Armamentarium

Abstract

deployment and so open thoraco-abdominal graft repair should be considered. doi:10.1016/j.hlc.2010.10.046 Pectoralis Major Musculocutaneous Flaps—An Effective Tool in the Cardiothoracic Surgeon’s Armamentarium Diana Tam ∗, John Tan Gold Coast Cardiac Surgery, Gold Coast, Australia Introduction: Median sternotomy continues to be the standard approach formost cardiac operations. Deep sternal wound infection is a significant cause ofmorbidity and mortality. The incidence reportedly ranges from0.5 to 5.9% [1]. Jurkiewitz pioneered the concept of vascular flap closure of the infected median sternotomy wound in 1980 [1]. Techniques using omentum, pectoralis major, rectus abdominis, external oblique and latissimus dorsi have been described. The use of pectoralis major musculocutaneous flaps to treat refractory sternal wound infections has gained popularity in recent years. Traditionally, these reconstructions have been referred to specialist reconstructive surgeons. The purpose of this research is to evaluate the outcome of sternal reconstruction carried out by the cardiothoracic surgeon. Methods: A review of the 25 cases of sternal wound [ Endovascular Stent Graft Repair for Penetrating Ulcers of Descending Thoracic Aorta—Cases Series and Review Deepak Mehrotra, Ms, Mch Fiacs ∗, Mark Webster, Fracp, Indran Ramanathan, Phd, Fracs, Parma Nand, Fracs Auckland City Hospital (Greenlane unit), Auckland, New Zealand Penetration aortic ulcers (PAU) are defined as breach in aortic initima secondary to ulceration of varied depth (including media) and severity. Optimal treatment for penetrating aortic ulcers has yet to be determined. On one side where definite surgical treatment is proposed for ascending aorta PAU, at other side PAUof descending thoracic aorta (DTA) is controversial. With the emergence of endoluminal stenting,which is less invasive and confers less morbidity and mortality, open surgical repair is for this particular entity is fading in current times. Although surgical treatment is very effective option, its invasive nature is critical in high risk group. We reviewed our experience atGreenlaneCardiothoracic unit with thoracic endografting for penetrating aortic ulcers of the descending thoracic aorta. Between July 2005 and August 2009,10 patients underwent thoracic endovascular stenting for this entity. The indications of stenting included PAU with or without dissection. Details of patients characteristics and outcome will be discussed. infections over a 10 yearperiod (2000–2009)wasperformed with the data extracted and analysed. One cardiothoracic surgeon performed all the operations. Results: There were 2 cases of failure in the sternal reconstructionsutilisingpectoralmyocutaneousflapsduring this ten-year period. In the first case, the sternal reconstruction failed because the patient continued to smoke cigarettes. When the sternal reconstruction broke down, his wound was subsequently treated with a rectus abdominis musculocutaneous flap and VAC dressings. In the second case, the patient was seen 4 years after a median sternotomy and coronary artery bypasswhichwas complicated by mediastinitis. He initially had a bilateral pectoralis major myocutaneous flap and a greater omentumflat reconstruction.At followup, thepatientwasnoted to have a herniation occurring through the mid part of his sternum where the pectoralis major flap has totally disrupted. The defect was repaired with Marlex mesh. Discussion: Muscle flap closure for refractory sternotomy infection should be considered as a part of the cardiothoracic surgeon’s armamentarium.