Management of Sternal Wounds with Bilateral Pectoralis Major Myocutaneous Advancement Flaps in 114 Consecutively Treated Patients: Refinements in Technique and Outcomes Analysis

Abstract

Because life-threatening sternal wound complications can occur following sternotomy, the optimal management of sternal wound infections remains an important topic. To decrease morbidity following operative treatment of these patients, the authors made a number of refinements in their treatment protocol over the past several years, particularly with regard to the extent of débridement, method of flap apposition, and management of drains. The purpose of this study was to obtain specific outcomes data by reviewing a large series of patients treated by a single surgeon. In this series of 114 consecutive sternal wounds treated by the senior author (Ascherman), patients were managed almost exclusively with débridement and immediate closure with bilateral pectoralis major myocutaneous advancement flaps. There were no intraoperative deaths. The 30-day perioperative mortality rate was 7.9 percent, with only one death directly related to sternal infection. Nineteen patients (16.7 percent) experienced postoperative morbidity, including partial wound dehiscences (5 percent), skin edge necrosis (5 percent), and seromas (3.5 percent). The authors advocate single-stage management of complicated sternal wounds with immediate débridement and bilateral pectoralis major myocutaneous advancement flaps. The procedure is rapid and effective. Refinements in technique have significantly lowered morbidity.

Erythropoietin-induced upregulation of endothelial nitric oxide synthase but not vascular endothelial growth factor prevents musculocutaneous tissue from ischemic damage

“…16,17 The associated morbidity and mortality represents a considerable health-care issue. 18,19 The aim of this study was to evaluate the NO-dependent effect of systemic EPO administration starting before surgical induction of acute persistent ischemia in musculocutaneous tissue of mice. The role of microcirculatory, angiogenic and cellular mechanisms were analyzed by intravital microcopy and immunhistochemical work-up.…”

Introduction to Chest Wall Reconstruction: Anatomy and Physiology of the Chest and Indications for Chest Wall Reconstruction

“…[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] The principal indications for chest wall reconstruction are tumor (primary or recurrent), 5 infection, radiation injury, and trauma, and the particularly unfortunate patient may have any combination of the above. 23 A thorough knowledge of anatomy is the foundation for a clear operative plan and fallback procedure.…”

“…[16][17][18][19][20][21] The pectoralis major muscle is a fan-shaped muscle that covers the anterior superior portion of the chest and forms the anterior axillary fold, attaching proximally to the medial half of the clavicle, sternum, and the superior six costal cartilages and distally to the intertubercular groove of the humerus (Fig. 4).…”

Fatores de risco para infecção de ferida esternal e aplicação do escore da STS em pacientes submetidos à cirurgia de revascularização miocárdica

“…For wounds with insufficient amount of bordering tissues different flaps were used according to the type of defect: advanced or rotated pectoralis major musculocutaneous flap [15] and omental flap followed by skin grafting. Composed breast skin flaps may be used in females [16].…”