Sternal dehiscence, a reconstructive challenge. Case report
René Edivaldo Hernández-Zamora1, Jorge Sotelo-Carbajal1, Gabriela Martínez-Maya2
1Hospital General Regional No.1 Instituto Mexicano del Seguro Social, Tijuana, Baja California, Mexico.
Insights
Post-sternotomy dehiscence, a serious complication after heart surgery, affects 10% of patients. A unilateral pectoralis muscle flap offers a viable surgical solution for sternal wound closure, ensuring stability and good outcomes.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Surgical Complications
Background:
- Sternotomy is a standard procedure for cardiac access.
- Post-sternotomy dehiscence is a significant complication with a 10% incidence.
- Risk factors include diabetes mellitus, obesity, and chronic obstructive pulmonary disease.
Observation:
- A clinical case of a 74-year-old male patient with sternal dehiscence post-myocardial revascularization is presented.
- This complication presents considerable complexity for the medical team.
Findings:
- The therapeutic approach involves infection management, necrotic tissue debridement, and coverage with vascularized tissue.
- A unilateral pectoralis muscle flap is a surgical alternative for sternal wound closure.
Implications:
- The pectoralis muscle flap provides adequate sternal stability.
- This surgical technique yields satisfactory functional and cosmetic results.
- Effective management of sternal dehiscence is crucial for patient recovery.
Introduction And Importance:
Sternotomy is the main surgical procedure used to access the heart and great vessels. Among its most important complications is post-sternotomy dehiscence with an incidence of 10 %; the main risk factors for its occurrence are diabetes mellitus, obesity or chronic obstructive pulmonary disease.
Case Presentation:
We present a clinical case of a 74-year-old male patient with sternal dehiscence secondary to sternotomy for myocardial revascularisation.
Clinical Discussion And Conclusions:
Surgical dehiscence of sternotomy presents remarkable complexity and poses a significant challenge to the medical team. The therapeutic approach focuses on addressing the infection, removing the necrotic tissue and then covering the area with highly vascularised tissue. Surgical alternatives include the possibility of using a unilateral pectoralis muscle flap, an option that provides adequate sternal stability and leads to satisfactory functional and cosmetic results.
