Pectoralis Muscle Flaps for Mediastinal Reconstruction

Abstract

Post-sternotomy mediastinitis from deep sternal wound infection is an infrequent but devastating complication of open-heart surgery. Historically, mortality has been reported as high as 50%. Early detection and aggressive surgical management has significantly improved outcomes. Removal of hardware and generous debridement of all necrotic tissue often results in large midline defects. In this article we describe using the pectoralis major for mediastinal reconstruction. The pectoralis major muscle is primarily fed by the internal mammary artery (IMA) and thoracoacromial artery. The pectoralis muscle is dissected in an en bloc fashion, and the flap is rotated or advanced on its pedicle and corresponding blood supply. For rotational flaps, the pectoralis is "turned over" or rotated inferomedially based on the IMA. With the advancement flap, the pectoralis pivots on the thoracoacromial artery, and typically covers more superiorly. These techniques can be used in combination for coverage of larger defects.