Sternal reconstruction after cardiac transplantation: a case of an oversized donor heart

We present a unique case of a cardiac transplant recipient who received an oversized heart.

To allow the chest to accommodate the organ, extensive resection of the bony chest wall was performed. As both pectoralis major myocutaneous flaps and omental transposition were insufficient to cover the wound, a chest rotational flap was chosen.

The large size of the flap allowed us to cover the entire protuberant heart, and the excess soft tissue absorbed the pulsations from the heart without placing tension on the suture line.

While the closure of complex sternal wounds can pose great challenges, the plastic surgeon possesses a variety of options including pectoralis, omental, rectus abdominus, latissimus dorsi as well as skin and subcutaneous flap closures to choose from.