title: Median sternotomy wound complication: the effect of reconstruction on lung function.
abstract: The objective of the study was to evaluate the lung function of patients with median sternotomy wound complication during the early postmedian sternotomy period and to compare the long-term pulmonary effects of reconstruction using pectoralis major and rectus abdominis muscle flaps. The percentage of predicted, standardized forced vital capacity (FVC); the standardized forced expiratory volume in 1 second (FEV1), and FEV1/FVC ratios of 45 patients with a median sternotomy wound complication were evaluated before and at a mean time of 10.6 months after wound reconstruction. Both mean FVC and FEV1 increased after wound revision compared with the prereconstruction results (8.4% and 9.2% increase, respectively). Patients with painful chest wall movement had the worst (60%) mean FVC and FEV1 before reconstruction when compared with a nonpainful complication. Reconstruction with a muscle flap was followed by an increase of 8.6% and 7.3% in FEV1 and FVC, respectively, from prereconstruction results. However, long-term results indicate that these patients have a mild, restrictive impairment of their lung function tests (LFTs), with about 80% of the predicted FVC and FEV1. Among the muscle flaps, the best improvement and best long-term LFT results were after sternectomy and reconstruction with a pectoralis major muscle flap as compared with a rectus abdominis muscle flap. Sternectomy and reconstruction with a muscle flap is a well-tolerated procedure associated with improvement of lung function compared with prereconstruction values. A pectoralis major muscle flap should be the first choice for muscle flap reconstruction while a rectus abdominis muscle flap should be reserved only for patients with good LFTs before reconstruction.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Cohen
authors.forename: Y
authors.initials: Y
authors.lastname: Yaniv
authors.forename: J
authors.initials: J
authors.lastname: Weiss
authors.forename: J
authors.initials: J
authors.lastname: Greif
authors.forename: E
authors.initials: E
authors.lastname: Gur
authors.forename: E
authors.initials: E
authors.lastname: Wertheym
authors.forename: R
authors.initials: R
authors.lastname: Shafir
mesh_terms: D000328:Adult; D000368:Aged; D002921:Cicatrix / Q000503:physiopathology / Q000601:surgery; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology*; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013147:Spirometry; D013249:Sternum / Q000601:surgery*; D013524:Surgical Flaps / Q000502:physiology; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D014797:Vital Capacity / Q000502:physiology*