Vascularized muscle flaps for life-threatening mediastinal wounds in children

Abstract

Vascularized muscle flaps have been shown to be highly effective in adults for complicated mediastinal and thoracic wounds. They result in infection control, wound coverage and preservation of life. Minimal experience exists with the use of these techniques in children. We review, our experience with vascularized muscle flaps between 1985 and 1993 in treating life-threatening mediastinal wounds in 8 children. The 8 patients ranged in age fom 1 day to 10 years; mean age was 2 years. Two patients had mediastinitis; one had an exposed Gore-Tex graft and the other had an exposed homograft conduit. One patient had a midline defect with exposed right ventricle immediately beneath the skin. One patient had trachael dehiscence after repair of an acquired tracheo-esophageal fistula from battery erosion. One patient with Marfan's syndrome had a pectus deformity and an unstable sternum after emergent reoperation for a false aortic aneurysm. Two neonates had their sternum left open with a temporary Silastic skin patch after orthotopic cardiac transplantation because of swelling of the donor heart. One transplant patient had wound dehiscence. Vascularized muscle flaps used to heal the mediastinal wounds in this group included pectoralis major (10), rectus abdominis (3), and cervical strap (1). One infant with asplenia and an exposed Gore-Tex graft that had a delayed vascularized muscle flap died of Candida sepsis. Seven of 8 patients (85%) healed their mediastinal wound. Prompt recognition of thoracic wound complications facilitates immediate surgical intervention to obtain primary closure with vascularized muscle flaps, which promotes rapid healing in these children.