Related Experiment Video
Updated: Aug 15, 2026
Engineered Vascularized Muscle Flap
Published on: January 11, 2016
Revisiting vascularized muscle flaps for complicated sternal wounds in children
Peter J Taub1, Matthew R Schulman, Suvro Sett
1Division of Plastic and Reconstructive Surgery, New York Medical College, Maria Fareri Children's Hospital, Valhalla, NY 10595, USA. peter@pjtaub.com
Insights
This study details a refined surgical technique for treating sternal dehiscence in neonates after open cardiac surgery. The innovative approach successfully closed a complex sternal wound, offering a new option for pediatric cardiac surgery patients.
Area of Science:
- Pediatric Cardiac Surgery
- Thoracic Reconstruction
- Congenital Heart Defect Management
Background:
- Postoperative sternal dehiscence and instability pose significant challenges in neonates following open cardiac surgery for congenital anomalies.
- Previous successful reconstructions involved pectoralis muscle flaps and rectus abdominis muscle flaps.
Observation:
- A 2-week-old neonate presented with sternal dehiscence and instability post-cardiac surgery.
- Initial management included debridement and vacuum-assisted closure (V.A.C.) system application.
Findings:
- A refined technique involved delayed transposition of the left rectus muscle with division of the inferior epigastric pedicle.
- Coverage of the sternal defect was achieved using the transposed rectus muscle and a full-thickness skin graft.
- The patient demonstrated a positive outcome with successful wound closure.
Implications:
- This modified rectus abdominis muscle flap technique offers a viable solution for complex sternal defects in neonates.
- The refined approach may improve outcomes and reduce complications in pediatric cardiac surgery patients requiring sternal reconstruction.
- Further studies are warranted to evaluate long-term efficacy and applicability across diverse patient populations.
Abstract:
Surgeons at our center previously reported a case of a 2-month-old infant who underwent closure of an infected sternal wound following open cardiac surgery with debridement followed by closure with bilateral pectoralis muscle flaps and a unilateral rectus abdominis muscle flap. The success of the procedure has spawned refinements in the technique, such as the one described herein. A 2-week-old neonate was evaluated for postoperative sternal dehiscence and instability following open cardiac surgery for severe congenital cardiac anomalies. Management included initial debridement and application of a vacuum-assisted closure (V.A.C.) system (KCI, Oxfordshire, UK). In conjunction with the final V.A.C. dressing change, the patient underwent delay of the left rectus muscle by division of the inferior epigastric pedicle. She subsequently underwent transposition of the left rectus muscle and application of a full-thickness skin graft for coverage of the sternal defect. She has since done well and still requires further invasive cardiac procedures.
