Treatment of infected median sternotomy wounds with a myocutaneous latissimus dorsi muscle flap.
Infected sternotomy wounds, particularly if accompanied by osteomyelitis, mediastinitis or pericarditis, are associated with significant morbidity, prolonged hospitalization and a mortality of up to 50%. Until the introduction of muscle flaps, the therapy of choice was debridement and open granulation or catheter irrigation. From 1994 to 1996, 9 patients with infected median sternotomy wounds were treated with a single-stage radical debridement and wound closure with a pedicled myocutaneous latissimus dorsi muscle flap (LDM). One patient received, in addition, a rectus abdominis muscle turnover flap. Healing was uneventful in all cases, with no respiratory complications or chest-wall instability. Shoulder strength was also unaffected. Functional and aesthetic outcome was good. The LDM provides a safe flap with little donor site morbidity. Compared to the most local muscle flaps, an intact IMA is not required. At the same time, length and cost of hospital stay are decreased.
Fansa
H
H
Department of Plastic, Reconstructive and Handsurgery, Medical Faculty, Otto-von-Guericke-University, Magdeburg, Germany.
Handstein
S
S
Schneider
W
W
D000368:Aged; D062109:Dermatologic Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D011237:Predictive Value of Tests; D012129:Respiratory Function Tests; D012132:Respiratory Muscles / Q000601:surgery; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery*; D013908:Thoracotomy / Q000009:adverse effects*; D014945:Wound Healing