Sternotomy wounds: rectus flap versus modified pectoral reconstruction.

Area of Science:

• Thoracic Surgery
• Plastic Surgery
• Wound Healing

Background:

• Infected sternotomy wounds complicate 0.5-8.4% of open heart surgeries, carrying high mortality rates.
• Pectoralis major flaps are successful for sternal wound closure but may be deficient in covering the lower sternum.
• Modifications like rectus flaps or fascia extensions aim to improve coverage for sternal dehiscence.

Purpose of the Study:

• To compare the effectiveness of bilateral pectoralis major muscle flaps with anterior rectus fascia extension against rectus abdominis muscle flaps alone for lower sternal wound coverage.

Main Methods:

• Retrospective study of 130 consecutive sternotomy wounds.
• Comparison of 41 pectoralis flaps with rectus fascia extension versus 56 rectus abdominis flaps.
• Evaluation of outcomes for addressing lower third sternal dehiscence.

Main Results:

• Both flap techniques showed similar success rates, postoperative courses, and morbidity/mortality.
• Pectoralis flaps with rectus fascia extension prevented superior dehiscence but not distal third dehiscence.
• Rectus abdominis flaps alone provided superior coverage for the inferior sternum.

Conclusions:

• Rectus abdominis muscle flaps are superior for covering the distal sternum in cases of dehiscence.
• Pectoralis flaps are preferred for superior sternal infections.
• Treatment choice should be based on the location of sternal wound dehiscence.