title: Successful treatment of deep sternal infections following open heart surgery by bilateral pectoralis major flaps.
abstract: OBJECTIVE
  Severe sternum necrosis requiring extended resection necessitates plastic reconstruction of the resulting defect and stabilization of the chest. We analyzed the outcome of patients undergoing bilateral pectoralis major flap repair on functional and cosmetic results, chest stabilization and pulmonary function.
  
  
  METHODS
  Twelve patients undergoing cardiac surgery between 1997 and 2001 suffered from a deep mediastinal wound infection and sternum necrosis. After a mean of two attempts of extensive wound debridement, all 12 patients underwent complete sternal resection with plastic reconstruction by bilateral pectoralis major flaps. Risk factors were obesity (n=10) and diabetes (n=11). Six months postoperatively patients underwent physical examination, pulmonary function testing and functional CT scan.
  
  
  RESULTS
  Three patients died in hospital (two septic multiorgan failure, one heart failure) and nine were discharged with complete wound closure. One patient suffered a lethal stroke during follow-up. At 6-month follow-up no recurrent sternum infection had occurred. Chest stability was satisfactory without impairment of pulmonary function (VC 77.5+/-12.1% at follow-up vs 77.8+/-12.5% preoperatively). Mobility and force of arms and shoulder were adequate; at CT scan the maximum distance change between the former sternoclavicular joint in inspiration versus expiration was minimal. Quality of life questionnaires showed no significant limitations except a disturbed sleep and mild restriction of executing hobbies and social activities.
  
  
  CONCLUSIONS
  Bilateral pectoralis major flap repair is a safe technique to cure severe mediastinitis necessitating complete sternal resection. Wounds close without extensive reconstructive surgery. Cosmetic results as well as stabilization of the chest were good. Patients reported an almost uncompromised quality of life without respiratory impairment.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Theodor-Stern-Kai 7, 60596, Frankfurt, Germany.
authors.forename: Armin Alex
authors.initials: AA
authors.lastname: Klesius
authors.forename: Omer
authors.initials: O
authors.lastname: Dzemali
authors.forename: Andreas
authors.initials: A
authors.lastname: Simon
authors.forename: Peter
authors.initials: P
authors.lastname: Kleine
authors.forename: Ulf
authors.initials: U
authors.lastname: Abdel-Rahman
authors.forename: Christopher
authors.initials: C
authors.lastname: Herzog
authors.forename: Gerhard
authors.initials: G
authors.lastname: Wimmer-Greinecker
authors.forename: Anton
authors.initials: A
authors.lastname: Moritz
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010369:Pectoralis Muscles / Q000637:transplantation*; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods / Q000534:rehabilitation; D013247:Sternoclavicular Joint / Q000000981:diagnostic imaging / Q000503:physiopathology; D013249:Sternum / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000534:rehabilitation / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome