Sternal Wound Reconstruction in Pediatric Patients: A 30-Year Single-Surgeon Experience
Michael B Amrami1, Myles N LaValley, Jeffrey A Ascherman
1Department of Surgery, Division of Plastic Surgery, NewYork-Presbyterian Hospital / Columbia University Irving Medical Center, New York, NY USA.
Background:
Deep sternal wound complications following cardiac surgery are well described in adults; however, perioperative characteristics and outcomes in pediatric patients remain poorly defined due to the rarity of the indication. This study evaluates the pediatric subgroup within a 30-year, single-surgeon sternal wound reconstruction experience.
Methods:
A retrospective review of a prospectively maintained database of 584 consecutive patients undergoing sternal wound reconstruction from 1995 to 2024 was performed. Patients younger than 18 years were compared with adults aged 18 years or older.
Results:
Six patients (1.0%) were younger than 18 years (mean age: 5.67±5.92 y) versus 578 adults (mean 64.74±12.48 y, P <0.0001). Two of the 6 pediatric patients required cardiac transplantation and one required reconstruction for congenital sternal absence. Pediatric patients were essentially free of the metabolic comorbidities that characterize adult patients undergoing reconstruction following CABG or valve surgery. Bilateral pectoralis major advancement flaps were the primary strategy in both groups; one pediatric patient additionally required an omental flap. Median total length of stay was 54.5 days [IQR: 17-104.5] versus 18 days in adults ( P =0.1100). No pediatric patient experienced wound dehiscence, seroma, hematoma, infectious complication, reoperation, or 30-day mortality. All 6 pediatric patients (100%) had no postoperative complications versus 55.71% of adults ( P =0.0376). Two patients died more than 30 days after reconstruction from underlying cardiac disease; no death was attributed to reconstruction. The markedly prolonged pediatric length of stay likely reflected the complexity of underlying congenital or transplant-related cardiac recovery rather than reconstructive failure.
Conclusion:
In this 30-year single-surgeon series, pediatric sternal wound reconstruction was rare but feasible. Standardized pectoralis-based techniques achieved zero 30-day mortality and no wound-related complications across a heterogeneous pediatric cohort, providing benchmark data for this underrepresented population. Early multidisciplinary coordination between cardiac and plastic surgery services remains essential.
