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One-stage management of infected sternotomy wounds using bilateral pectoralis major myocutaneous advancement flap
João de Deus e Brito1, Claudio Roberto Assumpção, Henrique Murad
1Faculty of Medicine of Federal University ofRio de Janeiro, RJ, Brasil. joaobrito@uol.com.br
Objective:
To assess the results of single-stage treatment of infected sternotomy wounds using bilateral pectorals major myocutaneous advancement flaps.
Methods:
Between January 2000 and July 2007, 1972 heart surgeries with median transesternal thoracotomy were performed. Thirteen (0.65%) patients presented wound infections and dehiscence after sternotomy. To treat those patients we adopted exclusively single-stage management, drainage, early intervention and immediate wounds closure using bilateral pectoralis major myocutaneous advancement flaps to the medium line of the sternum. Two patients with superficial wounds infection and other two who underwent torsion adjustment of the steel wire were not included in this study.
Results:
There was one death in the 30-day postoperative period. There was no intraoperative death. Four patients needed additional surgical intervention to drain residual seroma or local infection. There was total resolution of the sternal infection in 12 patients.
Conclusion:
The authors recommend the single-stage early management of sternotomy infected wounds with debridement, drainage and immediate closure of the wound using bilateral pectoralis major myocutaneous advancement flaps to the medium line of the sternum. The procedure is effective and may contribute to decrease the morbidity.
