Reconstruction of the median sternotomy wound dehiscence using the latissimus dorsi myocutaneous flap

Currently the internal thoracic artery (ITA) is the conduit of preference for coronary artery revascularization. Although this artery offers several advantages over the saphenous vein there is a higher incidence of postoperative sternal wound infection with its use. This incidence further increases with the use of bilateral internal thoracic arteries (BITA). The use of muscle or omental flaps to treat this complication has significantly reduced the morbidity and mortality. Typically the pectoralis major (PM) or the rectus abdominis (RA) muscles are the preferred method of reconstruction of the infected sternotomy wound.

In a retrospective study over a four-year period from February 1994 to October 1998, nine patients underwent reconstruction of an infected median sternotomy wound with a latissimus dorsi myocutaneous flap (LDMF).

All of the patients in our study were successfully treated with a single LDMF with the exception of one who required a rectus abdominis flap to cover the lateral aspect of the recalcitrant poststernotomy infected wound. There was a single patient who had a wound dehiscence at the donor site.

The LDMF is reliable and serves as an adjunct for treating sternotomy infections. The flap provides sufficient amount of pedicle length and muscle mass for coverage. Although there is a need to turn the patient into a lateral decubitus position once the debridement is performed the flap harvest and its mobilization is technically straightforward with a short operative time, 135 minutes on average with a range of 97 to 171 minutes. Furthermore, there exists an anatomical advantage in using the LDMF; harvest of the LDMF does not disrupt collateral blood supply to the sternum and parasternal tissues.