Sternal osteomyelitis: long-term results after pectoralis muscle flap reconstruction
Adrien Daigeler1, Aline Falkenstein, Werner Pennekamp
1Bochum, Germany From the Department of Plastic Surgery, Burn Center, Hand Surgery, Sarcoma Reference Center, the Institute of Diagnostic Radiology, Interventional Radiology and Nuclear Medicine, the Department of Internal Medicine, Division of Pneumology, Allergology and Sleep Medicine, Medical Clinic III, and the Department of Surgery, BG-University Hospital Bergmannsheil, Ruhr University Bochum.
Background:
Reports regarding long-term follow-up including quality-of-life assessment, pulmonary function, and donor-site morbidity after operative treatment for sternal osteomyelitis are rare.
Methods:
Data for 69 consecutive patients were acquired from patients' charts and contact with patients and general practitioners, with special reference to treatment and clinical course. Twenty-four patients were interviewed and physically examined (mean follow-up, 4 years; range, 1 to 9 years). Fifteen of the patients underwent pulmonary function tests, cine magnetic resonance imaging, and pectoralis strength testing using a dynamometer to record butterfly arm compressive movements. Statistical analysis was performed to identify factors influencing wound healing and survival.
Results:
Mortality rates were 10.1 percent at 30 days, 18.5 percent at 1 year, and 27.0 percent at 5 years (n = 69). In 36.2 percent of the patients, wound-healing difficulties requiring reoperation occurred. Independent of the extent of sternal resection, dynamic pulmonary function values were decreased compared with normal values (n = 15). Dynamometer assessment revealed decreases of 1.5 percent in dynamic maximum strength, 9.7 percent in maximum isometric strength, and 47.2 percent in strength endurance compared with the healthy age-matched control group. Magnetic resonance imaging showed no sign of recurrent osteomyelitis (n = 15). Muscle function was preserved in 93 percent of the patients. Eighty-three percent of the interviewed patients considered their general condition better and 17 percent considered it worse than before the treatment (n = 24).
Conclusions:
Pectoralis muscle transfer represents a safe and simple procedure. Although strength loss and pain are considerable, quality of life is improved significantly. Pulmonary function impairment is most likely not exclusively attributable to the muscle transfer or the sternum resection.
