Bilateral partial pectoralis major muscle turnover flaps for the management of deep sternal wound infection following cardiac surgery

Abstract

The pectoralis major muscle is a versatile flap used as an advancement or turnover flap for the treatment of deep sternal wound infection (DSWI) after median sternotomy. Advancement flaps provide suboptimal mass volume and sometimes cannot fully fill the dead space in the mediastinum. Turnover flaps can sufficiently cover the inferior sternum and fill dead space; however, the procedure requires disinsertion of the muscle from the humerus, resulting in functional loss and cosmetic deformity. In an attempt to optimize the benefits and minimize the drawbacks of both flaps, we developed a novel turnover flap method using the bilateral partial pectoralis major muscle. In this study, we introduce this new flap method and report its initial clinical results. Methods: The bilateral pectoralis major muscle is split into upper and lower parts according to the direction of the muscle fibers. The upper part of the pectoralis major muscle on one side and the lower part of the pectoralis major muscle on the other side were selected as the turnover flaps. The parts of the pectoralis major muscle selected as turnover flaps were transected vertically at the midline of the clavicle.Our novel turnover flap method was used to treat 11 patients with DSWI following cardiac surgery.Results: No deaths occurred in the group. In 10 patients, the chest incision healed without complications and reoperation, while 1 patient experienced delayed healing of the skin incision. None of the patients experienced subcutaneous hematoma or oozing that required reopening and drainage. The average hospitalization time was 14±7.9 days. After 6 months of follow-up, none of the patient had experienced recurrence of DSWI. Abnormal movement of the upper limbs or deformities of the chest wall were not detected in all 11 patients. Conclusions: Bilateral partial pectoralis major muscle turnover flaps are appropriate for the treatment of DSWI after cardiac surgery. This novel method does not only provide sufficient volume to fill the defect but can also preserve the function of the upper limbs and prevent cosmetic deformity of the chest wall.

Bilateral pectoralis major muscle flaps in treating deep sternal wound infection following CABG in diabetic patients：two cases report

“…[9,10] So surgical treatment has been recommended recently and muscle aps procedure, such as the pectoralis major or the rectus abdominis, has been widely accepted and proved to have satisfactory outcomes and safety. [11][12][13][14] Of 156 patients undergoing CABG Diabetes mellitus during 24 months in our study, DSW occurred in 2 patients (1.28%). Both of them received bilateral pectoralis major muscle aps with adequate infected tissue debridement and drainage and discharged with full recovery.…”

Reconstruction of Complex Anterior Chest Wall Defects: The Lasagna Technique

“…Furthermore, the harvest of three different flaps determines a relevant increase in intraoperative time. The harvest of the bilateral pectoralis flap may cause some kind of morbidity, which is, however, usually well tolerated according both to the literature 15,28 and to our previous published experience. [24][25][26]29,30 A limitation of this report is a short follow-up time, which did not allow us to analyze long-term results in terms of respiratory function.…”

Bilateral Pectoralis Major Muscle Flaps in Treating Deep Sternal Wound Infection following CABG in Diabetic Patients: Two Case Reports

“…DSWI without surgical treatment has a mortality rate of about 70%-80% [1]. Surgical treatment is recommended muscle flaps using the pectoralis major or the rectus abdominis, have been proved to be safe with good outcomes [2]. Of 156 diabetic patients undergoing CABG during a 24 month in our hospital, DSWI occurred in 2 patients (1.28%).…”