Pectoralis muscle flap reconstruction of pediatric sternal wound infections
David Zabel1, Benjamin D Eskra, Dimitri Laddis
1Advanced Plastic Surgery Center, Newark, Delaware, USA.
Insights
Pectoralis muscle flap reconstruction effectively treats pediatric sternal wound infections (SWI), a serious complication after median sternotomy. This method leads to well-healed wounds with good cosmetic and functional outcomes in children.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Infectious Disease
Background:
- Sternal wound infection (SWI) is a severe complication following median sternotomy in pediatric and adult patients.
- Muscle flap reconstruction, particularly pectoralis muscle flaps, has reduced SWI morbidity and mortality.
- The use of pectoralis muscle flaps in pediatric SWI reconstruction is not well-documented.
Purpose of the Study:
- To review the experience of using pectoralis muscle flaps for chest wall reconstruction in pediatric patients with SWI.
- To evaluate the efficacy and outcomes of pectoralis muscle flap advancement in children.
Main Methods:
- Retrospective review of 1,200 pediatric median sternotomies (1992-1997).
- Identification of SWI cases and analysis of surgical management by a single surgeon.
- Reconstruction using unilateral or bilateral pectoralis muscle flap advancements.
Main Results:
- Nine pediatric patients (0.75% incidence) developed SWI.
- Eight patients underwent pectoralis muscle flap reconstruction (25% unilateral, 75% bilateral).
- Reconstructions resulted in well-healed wounds, satisfactory cosmesis, and no documented functional deficits, with an average hospital stay of 9 days post-reconstruction.
Conclusions:
- Pectoralis muscle flap advancement is a successful technique for functional and esthetic reconstruction in pediatric patients with SWI.
- Aggressive surgical management, including muscle flap reconstruction, significantly lowers morbidity and mortality associated with SWI.
- This approach offers a viable solution for chest wall defects following sternal wound infections in children.
Abstract:
Sternal wound infection (SWI) is a life-threatening complication in both the pediatric and adult population. The morbidity and mortality of SWIs have decreased with the use of muscle flap reconstruction of the chest wall. Although the pectoralis muscle flap is the most frequently used flap in adults for reconstruction after SWI, its use in children has not been well described. To review current experience with the use of the pectoralis muscle flap in a pediatric population, a retrospective review of 1,200 consecutive median sternotomies occurring at the Children's Hospital of Pittsburgh between 1992 and 1997 was performed. All cases of postoperative SWI were identified, and the operative management was performed by a single surgeon. Reconstruction was performed with the use of unilateral or bilateral pectoral muscle flap advancements. Sternal wound infections developed in nine patients (0.75% incidence). The mean duration from initial sternotomy to the time of presentation of deep SWI was 39.5 days. Eight patients underwent reconstruction using pectoralis muscle advancement flaps. Two patients (25%) were reconstructed with a unilateral pectoralis advancement flap, whereas six patients (75%) required bilateral advancement flaps. One patient was treated with conservative management. The average length of stay after reconstruction was 9 +/- 4 days. Duration of follow-up ranged from 3 to 42 months (mean: 16 +/- 12 months). All reconstructions ultimately resulted in well-healed wounds with satisfactory cosmesis. No developmental or functional deficits have been documented in follow-up visits. Sternal wound infection is a serious postoperative complication of median sternotomy. Aggressive operative management with the use of muscle flap reconstruction has helped to lower the morbidity and mortality of this infection. The successful use of pectoralis muscle flap advancement for functional and esthetic reconstruction of the chest wall in children is described.
