Related Experiment Videos
Sternal wound debridement and muscle flap reconstruction: functional implications
David T Netscher1, Firas Eladoumikdachi, Piper M McHugh
1Division of Plastic Surgery, Baylor College of Medicine, Houston, TX, USA.
Annals of Plastic Surgery
|August 5, 2003
Summary
Poststernotomy infections after cardiovascular surgery can lead to significant morbidity. Reconstruction with muscle flaps improves survival but may affect physical function, with pain and satisfaction differing between uncomplicated and reconstructed patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Infectious Disease
Background:
- Poststernotomy infections complicate up to 5% of median sternotomy incisions after cardiovascular surgery.
- Historically, mortality for these infections was high (37.5%) before reconstructive techniques were standard.
- Sternal debridement with muscle or omental flap reconstruction significantly reduced mortality to over 5%.
Purpose of the Study:
- To evaluate long-term physical functional deficits and outcomes after cardiovascular surgery involving sternal wound infection and reconstruction.
- To compare strength, pain, daily living activities, and patient satisfaction in patients with and without prior sternal wound complications.
Main Methods:
- Two groups of coronary bypass surgery patients (at least 6 months post-op) were evaluated.
- One group had no complications; the other had sternal wound infections requiring debridement and muscle flap reconstruction (pectoralis major or rectus abdominis).
- Pectoral and rectus muscle strength, pain, daily living activity function, and patient satisfaction were assessed via testing and questionnaires.
Main Results:
- Significant differences (p<0.05) were found in pain and patient satisfaction (appearance, general function) between the groups.
- Pectoral muscle function and strength were significantly reduced when the pectoralis major muscle was transposed.
- Rectus abdominis muscle strength was unaffected by transposition of a single rectus muscle.
Conclusions:
- Physical morbidity and strength loss after sternal wound reconstruction appear primarily related to sternal instability from infection and debridement, not muscle loss.
- While reconstruction improves survival, functional deficits like pain and reduced satisfaction can occur, particularly with pectoralis muscle transposition.