Therapeutic Outcomes of Pectoralis Major Muscle Turnover Flap in Mediastinitis

Abstract

BackgroundThis study aimed to evaluate the therapeutic results and safety of pectoralis major muscle turnover flaps in the treatment of mediastinitis after coronary artery bypass grafting (CABG) procedures.MethodsData regarding 33 patients with post-CABG deep sternal wound infections (DSWIs) who underwent pectoralis major muscle turnover flap procedures in the Emam Reza and Ghaem Hospitals of Mashhad, Iran were reviewed in this study. For each patient, age, sex, hospital stay duration, remission, recurrence, and associated morbidity and mortality were evaluated.ResultsOf the 2,447 CABG procedures that were carried out during the time period encompassed by our study, DSWIs occurred in 61 patients (2.5%). Of these 61 patients, 33 patients (nine females [27.3%] and 24 males [72.7%]) with an average age of 63±4.54 years underwent pectoralis major muscle turnover flap placement. Symptoms of infection mainly occurred within the first 10 days after surgery (mean, 10.24±13.62 days). The most common risk factor for DSWIs was obesity (n=16, 48.4%) followed by diabetes mellitus (n=13, 39.4%). Bilateral and unilateral pectoralis major muscle turnover flaps were performed in 20 patients (60.6%) and 13 patients (39.4%), respectively. Complete remission was achieved in 25 patients (75.7%), with no recurrence in the follow-up period. Four patients (12.1%) needed reoperation. The mean hospitalization time was 11.69±6.516 days. Four patients (12.1%) died during the course of the study: three due to the postoperative complication of respiratory failure and one due to pulmonary thromboembolism.ConclusionPectoralis major muscle turnover flaps are an optimal technique in the treatment of post-CABG mediastinitis. In addition to leading to favorable therapeutic results, this flap is associated with minimal morbidity and mortality, as well as a short hospitalization time.

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

“…Besides, some complications may take place, for example the deficit of flap perfusion (leading to flap necrosis), the weakening of the abdominal wall, etc. [ 2 , 6 ] .…”

“…Besides, the omental flap does not lead to sternal stabilization and it does not have skin coverage. Its main indication is related to situations in which other flaps have failed [ 2 , 6 , 16 ] .…”

“…The reconstruction with the pectoralis major muscle flap mobilized bilaterally has been the first choice in several centers, since it does not show greater adverse effects on pulmonary function and even improves the parameters of spirometry, cosmetic results and thoracic stabilization [ 2 , 3 , 6 , 7 ] . However, it may lead to impairment to execute hobbies and social activities, as pointed by Klesius et al [ 6 ] , after analyzing the results from a quality of life questionnaire.…”

“…In the 1950s, Shumacker and Lurie [ 1 ] introduced the median sternotomy as an access route for cardiac surgery, including coronary artery bypass procedures [ 2 ] . Although the incidence of infection in the median sternotomy is relatively low (1-10%), when associated with mediastinitis, it courses with high morbidity and mortality rate ranging from 14 to 47% [ 3 , 4 ] .…”

“…Among the various methods used for the treatment of the sternal wound dehiscence, medical literature highlights the utilization of the bilateral pectoralis major muscle flap [ 2 , 3 , 6 , 7 ] . Although it is possible to use only one of the pectoralis major muscles, there are scarce sources of literature about the application of the unilateral pectoralis major muscle flap [ 8 - 11 ] , based on the thoracoacromial artery.…”