Use of the pectoralis major fasciocutaneous flap in the treatment of post sternotomy dehiscence: a new approach

Jaime Anger,Renato Tambellini Arnoni,Daniel Chagas Dantas,Antonio Flavio Sanches Almeida,Pedro Silvio Farsky

doi:10.1590/s1679-45082012000400010

Abstract

To describe a new surgical technique for the treatment dehiscence after median thoracotomy transsternal using fasciocutaneous flap composed of the pectoralis major fascia. Between January 2009 and December 2010, from 1,573 patients submitted to coronary artery bypass graft, 21 developed wound dehiscence after sternotomy and were treated with bilateral pectoralis major muscle fasciocutaneous flap, including partial portion of the rectus abdominis fascia. Patients were followed for a minimum of 90 days postoperatively. All patients had favorable outcome following 90 days, not having any partial or total dehiscence. There were no cases of postoperative infection. The procedure was rapid and effective. Compared with techniques using muscle, myocutaneous or greater omentum flaps, this surgery was less aggressive and maintained the integrity of tissue region. The authors considered that this technique should be used as the first option, leaving the flaps to more complex cases of relapse.

Highlights

The median transsternal thoracotomy was first described as a surgical approach in cardiac surgery in 1957, and since it has been widely used
From January 1st, 2009 to December 31st, 2010, a total of 1573 patients were submitted to myocardial revascularization surgery by transsternal approach at the Instituto Dante Pazzanese de Cardiologia de São Paulo
Twenty-one patients were treated with bilateral fasciocutaneous flap of pectoralis major; two with breast tissue flap; and three with myocutaneous flap from pectoralis major – in that, two were bilateral and one unilateral

Summary

INTRODUCTION

The median transsternal thoracotomy was first described as a surgical approach in cardiac surgery in 1957, and since it has been widely used. In cases of acute infection, the management comprises early debridement, use of antibiotics and, in some patients, use of a pectoralis or omentum flap to improve vascularization[3,4,5]. Some of these patients progress with dehiscence of sutures and chronic wound. Considering the favorable results achieved, we used flaps containing skin and subcutaneous tissue, including the pectoralis major fascia in larger wounds. In this report, this new technique is presented to repair post-sternotomy wound

METHODS

DISCUSSION

Findings

CONCLUSION