Related Experiment Video
Updated: Aug 6, 2026
Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer
Published on: March 1, 2015
Muscle flap reconstruction of pediatric poststernotomy wound infections
R T Grant1, A S Breitbart, V Parnell
1Division of Plastic and Reconstructive Surgery, North Shore University Hospital-NYU School of Medicine, Manhasset 11030, USA.
Insights
Deep sternal wound infections after pediatric open-heart surgery are rare but can be treated effectively with muscle flap reconstruction. This one-stage procedure offers a reliable solution for healing complex sternal wounds in children.
Area of Science:
- Cardiothoracic Surgery
- Pediatric Surgery
- Wound Healing
Background:
- Sternal wound infections following pediatric open-heart surgery are infrequent but serious complications.
- Median sternotomy is a common approach for pediatric cardiac procedures.
- Deep sternal wound infections can lead to significant morbidity.
Observation:
- Four out of 600 pediatric patients undergoing median sternotomies required muscle flap reconstruction for deep sternal wound infections.
- Risk factors identified included multiple sternotomies, prior superficial infections, and immunocompromised status.
- Reconstruction utilized bilateral pectoralis major muscle flaps or vertical rectus abdominis muscle flaps.
Findings:
- Muscle flap reconstruction provided an effective one-stage treatment for deep sternal wound infections and sternal instability in pediatric patients.
- All four patients achieved complete wound healing following the reconstructive procedure.
- The choice of flap in pediatric patients may differ from adults due to anatomical considerations and prior surgical history.
Implications:
- Muscle flap reconstruction is a viable and effective surgical option for managing deep sternal wound infections in pediatric cardiac surgery.
- Careful patient selection and consideration of anatomical factors are crucial for successful flap-based reconstruction in this population.
- This approach can lead to successful wound closure and improved outcomes for children with complex sternal complications.
Abstract:
Sternal wound infections following pediatric open-heart procedures occur infrequently. Four of our last 600 consecutive pediatric open-heart median sternotomies (1991 to 1996) required muscle flap reconstruction for treatment of deeply infected sternotomy wounds. Risk factors included multiple sternotomies, previous superficial infection, and immunocompromised states. Two patients were closed with bilateral pectoralis muscle flaps. The 2 other patients were closed with vertical rectus abdominis muscle flaps; 1 including an attached skin paddle. While the pectoralis major muscle flap is the first flap of choice utilized in adult patients, in pediatric patients a different hierarchy of flap selection is often necessary. The chest wall often has multiple scars from previous procedures, limiting use of the pectoralis muscle. In small infants the pectoralis muscle can be thin and inadequate for large sternal defects. All patients achieved healed wounds. Muscle flap reconstruction of pediatric sternal wounds can be an effective one-stage treatment for deep sternal wound infections with sternal instability.
