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Split pectoralis major flaps for mediastinal wound coverage: a 12-year experience
Edward N Li1, Nelson H Goldberg, Sheri Slezak
1Division of Plastic and Reconstructive Surgery, University of Maryland Medical Systems, Baltimore, MD, USA.
Annals of Plastic Surgery
|September 24, 2004
Summary
Pectoralis major flaps are the preferred choice for treating poststernotomy mediastinitis, offering effective wound coverage. Diabetic patients face a significantly higher risk of reoperation following sternal reconstruction.
Area of Science:
- Plastic Surgery
- Thoracic Surgery
- Infectious Disease
Background:
- Poststernotomy mediastinitis is a rare but severe complication after median sternotomy.
- Standard treatment involves aggressive debridement and flap reconstruction for mediastinal wound coverage.
Purpose of the Study:
- To evaluate the effectiveness of various flap types in managing poststernotomy mediastinitis.
- To identify risk factors for reoperation and mortality in these patients.
Main Methods:
- A retrospective review of 69 patients undergoing mediastinal wound coverage between 1989 and 2002.
- Analysis of 105 flaps, with a focus on pectoralis major flaps.
- Assessment of comorbidities, reoperation rates, and mortality.
Main Results:
- Pectoralis major flaps were used in 90% of cases, with 58% receiving a single flap.
- Reoperation was required in 14.5% of patients; diabetes mellitus significantly increased this risk (9.1 times).
- Mortality within 30 days was 5.8%.
Conclusions:
- The pectoralis major turnover flap is highly effective for sternal reconstruction, providing superior coverage.
- Minimizing the need for abdominal flaps reduces associated morbidity.
- Diabetic patients require careful consideration due to elevated reoperation risks.