Sternal Wound Reconstruction in Pediatric Patients: A 30-Year Single-Surgeon Experience

Area of Science:

• Pediatric Surgery
• Thoracic Surgery
• Plastic Surgery

Background:

• Deep sternal wound complications are well-documented in adults after cardiac surgery.
• Data on pediatric sternal wound complications and outcomes are limited due to the rarity of the condition.
• This study examines the pediatric subgroup within a 30-year sternal wound reconstruction experience.

Purpose of the Study:

• To evaluate the perioperative characteristics and outcomes of pediatric patients undergoing sternal wound reconstruction.
• To compare pediatric outcomes with adult outcomes in sternal wound reconstruction.
• To establish benchmark data for pediatric sternal wound reconstruction.

Main Methods:

• Retrospective review of a prospectively maintained database (1995-2024).
• Analysis of 584 sternal wound reconstructions, comparing pediatric (<18 years) and adult (≥18 years) subgroups.
• Comparison of patient demographics, comorbidities, surgical techniques, and postoperative outcomes.

Main Results:

• Six pediatric patients (1.0%) were identified, with two requiring cardiac transplantation and one reconstruction for congenital sternal absence.
• Pediatric patients had fewer metabolic comorbidities compared to adults.
• No pediatric patient experienced wound dehiscence, seroma, hematoma, infection, reoperation, or 30-day mortality, contrasting with 55.71% of adults (P=0.0376).
• The prolonged pediatric length of stay was attributed to complex cardiac recovery, not reconstructive failure.

Conclusions:

• Pediatric sternal wound reconstruction, though rare, is feasible using standardized pectoralis-based techniques.
• These techniques resulted in zero 30-day mortality and no wound-related complications in pediatric patients.
• Multidisciplinary coordination between cardiac and plastic surgery is essential for optimal outcomes in this population.