Simultaneous pectoralis major-latissimus dorsi myocutaneous flap: An option of reconstruction for open sternal wounds

Abstract

Summary Management of the open sternal wound after surgery is a challenge. We report a retrospective series of cases with regard to the management of sternal wounds according to our own experience and a review of the related literature. A retrospective chart review from June 2007 to February 2010 of patients with infective and open sternal wounds after surgery was performed. There were seven patients with a previous history of type A aortic dissection treated with the Bentall operation, thymoma with excision, mitral and tricuspid regurgitation with double valve replacement, and acute myocardial infarction with a ventricular-assist device or coronary artery bypass graft. All wound cultures of the seven patients showed positive findings. All patients received the latissimus dorsi (LD) myocutaneous flap for lower sternal wound reconstruction under the decubitus position and a contralateral pedicled rotated pectoralis major (PM) myocutaneous flap for the upper sternal wound. The residual wound was covered with a split-thickness skin graft. The mean age of the seven patients, including four males and three females, was 58.1 years (range: 33–73 years). The mean follow-up was 37.7 months (range: 30–44 months). The average time span between the final debridement and the flap reconstruction procedure was 5.2 ± 1.8 days. The harvested area of LD myocutaneous flap ranged from 25 × 10 cm2 to 15 × 8 cm2, and the area of PM myocutaneous flap ranged from 15×15 cm2 to 10 × 5 cm2. Four of seven patients had an omental flap initially, but salvage surgery was performed using a simultaneous pectoralis major-LD flap. Three cases underwent simultaneous PM-LD flap directly. One patient expired on postoperative Day 4 because of sudden ventricular fibrillation, but no postoperative complications were noted in the other six patients. With long-term follow-up, all patients survived without significant complications. The simultaneous PM-LD myocutaneous flap is a reliable option for open sternal wound reconstruction.