title: Our experience using the vertical rectus abdominis muscle flap for reconstruction in 12 patients with dehiscence of a median sternotomy wound and mediastinitis.
abstract: The vertical rectus abdominis (VRAM) flap has been used for reconstruction of sternal defects, particularly in the inferior third, since it was first described 20 years ago. We describe 12 patients with mediastinitis or chronic sternal osteomyelitis after sternotomy treated between 1994 and 1997, nine performed at the Royal Hospitals Trust, London. Sternal osteomyelitis and mediastinitis after median sternotomy is an uncommon (0.4%-8.4%) but often fatal condition. Vascularised pedicles are the treatment of choice, and VRAM flaps were used in all cases. We report good long-term outcome with a follow up of 2-5 years, and no long-term morbidity relating to the VRAM reconstruction. We had only one partial failure of a flap. The operations were largely done in hospitals away from the plastic surgical unit in extremely sick patients, which illustrates the importance of multidisciplinary management to reduce hospital stay, mortality, and morbidity. We argue that early involvement of plastic surgical specialists in the treatment of sternal dehiscence is essential to ensure a successful outcome.
authors.affiliation: St George's Hospital, London, UK.
authors.forename: James H W
authors.initials: JH
authors.lastname: Clarkson
authors.forename: Fey
authors.initials: F
authors.lastname: Probst
authors.forename: Niri S
authors.initials: NS
authors.lastname: Niranjan
authors.forename: Claudia
authors.initials: C
authors.lastname: Meuli
authors.forename: Paul
authors.initials: P
authors.lastname: Vogt
authors.forename: Disa
authors.initials: D
authors.lastname: Lidman
authors.forename: Lena C
authors.initials: LC
authors.lastname: Andersson
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000209:etiology; D008875:Middle Aged; D010019:Osteomyelitis / Q000209:etiology; D010348:Patient Care Team; D019651:Plastic Surgery Procedures / Q000379:methods*; D017568:Rectus Abdominis / Q000098:blood supply*; D012017:Referral and Consultation; D013249:Sternum / Q000098:blood supply / Q000382:microbiology / Q000601:surgery*; D013518:Surgery, Plastic; D013524:Surgical Flaps / Q000098:blood supply*; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*; D016896:Treatment Outcome