Reconstruction for sternal osteomyelitis at the lower third of sternum

Sternal wound infection causes considerable morbidity and mortality for open-heart patients. Treatment of the wounds at the upper two-thirds is easier with pectoralis major muscle or other flaps. However, there would be more problems with the lower one-third sternal wounds.

From 1983 to 2007, 32 patients of osteomyelitis involving the lower sternum were treated with one of the following methods: (1) Latissimus dorsi with fasciocutaneous extension flap (2) Tri-pedicled pectoralis major musculocutaneous flap (3) Pectoralis major muscle with rectus abdominis muscle flap (4) Pectoralis major muscle with omentum flap (5) Free vastus lateralis muscle flap and skin grafting

The viability of these flaps was good except for one of the five patients with pectoralis major-rectus abdominis muscle. One of the patients from the free vastus lateralis muscle group died of heart failure 6 weeks after surgery, but the coverage of sternal wound was successful. No recurrent sternal infection was found.

For coverage of sternal wounds, the transferred tissue must have optimal blood supply in order to overcome the infection. According to the descending degree of ease, the ladder of reconstruction is from (1) to (5), depending on the relative length of the sternal wound and the arc of rotation of these flaps. In pectoralis major with rectus abdominis flap group, it is suggested that the upper sternal wound be covered with pectoralis major muscle but lower third sternal wounds with omentum instead of rectus abdominis muscle.