Application of Unilateral Pectoralis Major Muscle Flap in the Treatment of Sternal Wound Dehiscence

Abstract

ObjectiveThis study aims to report the use of the unilateral pectoralis major muscle flap for the treatment of the sternal wound dehiscence.MethodsA retrospective study including patients who underwent unilateral pectoralis major muscle flap was performed for the treatment of sternotomy dehiscence due to coronary artery bypass, valve replacement, congenital heart disease correction and mediastinitis, between 1997 and 2016. Data from the epidemiological profile of patients, length of hospital stay, postoperative complications and mortality rate were obtained.ResultsDuring this period, 11 patients had their dehiscence of sternotomy treated by unilateral pectoralis major muscle flap. The patients had a mean age of 54.7 years, the mean hospital stay after flap reconstruction was 17.9 days (from 7 to 52 days). In two patients, it was necessary to harvest a flap from the rectus abdominis fascia, in association with the pectoralis major muscle flap, to facilitate the closure of the distal wound. In the postoperative period, seroma discharge from the surgical wound was observed in six patients, five reported intense pain (temporary), three had partial cutaneous dehiscence, and two presented granuloma of the incision.ConclusionThe complex wound from sternotomy dehiscences presents itself as a challenge to surgical teams. Treatment should include debridement of necrotic tissue and preferably coverage with well-vascularized tissue. We propose that the unilateral pectoralis major muscle flap is an interesting and low morbidity option for the reconstruction of sternal wound dehiscences, with proper sternum stability and satisfactory functional and aesthetic outcomes.

Reconstruction of sternal defects after sternotomy with postoperative osteomyelitis, using a unilateral pectoralis major advancement muscle flap

“…This can be explained by the advanced age of the patients as well as a high degree of cardiovascular comorbidities, which are prominent risk factors for deep sternal wound infection 3 . However, the rate of complications is still in line with previous reports 13,16,18 . Postoperative bleeding was the most common cause of reoperation (Table 3).…”

“…Both methods had similar results regarding mortality, morbidity, and complications 12 . Horácio et al showed good results after the use of unilateral pectoral muscle flaps in their study of 11 patients 13 . The main advantage of the unilateral pectoral muscle flap is that it preserves full strength in at least one arm, and the possibility of saving the contralateral pectoralis major in case of possible flap failure.…”

“…In our department we have considerable experience with the unilateral pectoralis major muscle advancement flap, which has been used to cover most of the sternal defects that have presented to our reconstructive surgical team. To the best of our knowledge, there are relatively few reports that focus solely on this surgical approach [10][11][12][13] .…”

The role of the unilateral pectoralis major muscle flap in the treatment of deep sternal wound infection and dehiscence

“…This is a low morbidity option, with proper sternum stability and satisfactory functional and esthetic outcomes. 8 The unilateral pectoralis major muscle flap is a more conservative technique when compared to the bilateral pectoralis muscle flap, to decrease potential functional impairments due to the donor area deficit. Also, it is associated with shorter surgical time and a low rate of postoperative complications.…”

Modified internal mammary artery perforator flap in treatment of sternal wound complications

“…Bilateral flaps can be needed to obliterate sufficiently the dead space[1]. However, unilateral pectoralis major muscle flap and it's multiple modifications, including split muscle flap, are useful with many patients[28,29,30]. The operation is brief and the muscles are easy to dissect.…”