Modified internal mammary artery perforator flap in treatment of sternal wound complications

There are multiple treatment strategies and flap options to cover defects after deep sternal wound infections and other similar sternal defects. The choice of flap is made according to surgeons' preferences and the size and location of the defect. Our aim is to introduce a new option to cover these kinds of defects with an internal mammary artery perforator flap combined with a pectoralis major muscle flap mostly raised with a muscle-sparing technique.

We treated 13 patients with a sternal defect after cardiothoracic operations with this technique between 2010-2016. Ten patients had a deep sternal wound infection, two had an infection of the prosthesis after carotico-subclavian bypass and one had a fragmented sternum. Nine patients were treated with an internal mammary artery perforator fasciocutaneous flap with a muscle-sparing pectoralis major muscle flap and four patients with an internal mammary artery perforator fasciocutaneous flap combined with a right pectoralis major muscle flap.

Three patients (23%) experienced major complications and four patients (31%) had conservatively treated minor complications. There were no flap losses.

This combination of flaps is a suitable option for patients with large defects in whom direct skin closure is not possible. It can be utilized for defects comprising the entire vertical length of the sternum. These are local flaps with a short operation time and are therefore most suitable for patients with comorbidities in whom major surgery is not an option.