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Pectoralis major muscle flap for deep sternal wound infection in neonates
1Department of Cardiothoracic Surgery, Imaging and Roentgenology Institute, Schneider Medical Center for Children, Petah-Tikva, Israel.
Insights
Deep sternotomy wound infections are a serious risk in neonates undergoing cardiac surgery. Pectoralis major muscle flap (PMF) reconstruction effectively manages these infections, ensuring survival and normal development.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Neonatal Care
Background:
- Deep sternotomy wound infections pose a significant threat in neonates post-cardiac surgery.
- Management and follow-up of these infections using pectoralis major muscle flap (PMF) reconstruction are crucial.
Purpose of the Study:
- To report on the management and outcomes of deep sternotomy wound infections in neonates treated with PMF reconstruction.
- To compare the incidence of sternal wound complications between neonates and infants.
Main Methods:
- Review of 720 pediatric cardiac operations (108 neonates, 612 infants) from 1995-1998.
- Analysis of 9 children (1.25%) who developed deep sternotomy wound infections and underwent PMF reconstruction, with a focus on 6 neonates.
- Follow-up included growth, development, physical exams, and CT scans.
Main Results:
- Neonatal sternal wound complication incidence (5.5%) was significantly higher than in infants (0.5%).
- All 6 neonates treated with PMF reconstruction (unilateral or bilateral) survived with successfully healed sternal wounds.
- Follow-up (mean 16.5 months) showed expected growth and development with no signs of chronic infection.
Conclusions:
- Early recognition and surgical treatment of sternal wound complications are vital.
- Pectoralis major muscle flap (PMF) utilization facilitates rapid wound healing, preserves life in critically ill neonates, and minimizes developmental issues.
Background:
Deep sternotomy wound infections during the neonatal period, their management utilizing the pectoralis major muscle flap (PMF), and their follow-up are reported.
Methods:
Seven hundred-twenty consecutive pediatric cardiac operations performed from 1995 to mid 1998 in 108 neonates and 612 infants are reviewed. Nine children (1.25%), 6 neonates and 3 infants, developed deep sternotomy wound infections and underwent PMF reconstruction. The 6 neonates are reviewed. Their follow-up includes growth and development reports, physical examination, and computerized tomographic scans of the chest.
Results:
The incidence of sternal wound complications in our neonatal patients (5.5%, 6 of 108) was significantly higher than in the infantile group (0.5%, 3 of 612), (p = 0.0001, odds ratio = 11.94). Five neonates were treated with a unilateral, turnover PMF reconstruction. One patient was treated by a bilateral rotational PMF. All sternal wounds healed successfully, and all patients survived. In a follow-up period, ranging from 6 to 31 months (mean 16.5 months), the growth and development of all operated neonates was as expected for their age. There were no signs of chronic sternal infection in any of them.
Conclusions:
Early recognition of sternal wound complications should facilitate surgical treatment. Utilizing the PMF promotes rapid wound healing and preservation of life in these severely ill neonates, with minimal developmental problems.