title: Management of sternal wounds with pectoralis major musculocutaneous advancement flaps in patients with a history of chest wall irradiation.
abstract: Although debridement and pectoralis major musculocutaneous advancement flap closure has proved to be an effective treatment of sternal wounds in the general population, the purpose of this study was to examine the use of these flaps in patients with previously irradiated chest walls. The authors examined 5 patients with a history of breast cancer and chest wall radiation therapy who developed poststernotomy wound complications that were treated with debridement and pectoralis major musculocutaneous advancement flaps. The average patient age was 76 years. Three patients had previously undergone a radical mastectomy and had only 1 pectoralis major muscle remaining. There were no intraoperative deaths. One patient died during the 30-day postoperative period. There were no hematomas, seromas, or dehiscences. One woman developed a postoperative wound infection. Functional and aesthetic results were excellent. This study demonstrates that early, aggressive sternal debridement and closure with pectoralis major musculocutaneous advancement flaps is effective in patients with a history of chest wall irradiation, including those who have had 1 pectoralis major muscle previously resected.
authors.affiliation: Division of Plastic Surgery, Columbia University College of Physicians & Surgeons, New York, NY 10032, USA. jaa@columbia.edu
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Ascherman
authors.forename: Arthur E
authors.initials: AE
authors.lastname: Desrosiers
authors.forename: Martin I
authors.initials: MI
authors.lastname: Newman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000628:therapy; D005260:Female; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D010369:Pectoralis Muscles / Q000637:transplantation*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013249:Sternum / Q000601:surgery; D013524:Surgical Flaps; D035441:Thoracic Wall / Q000528:radiation effects; D013908:Thoracotomy / Q000009:adverse effects*; D016896:Treatment Outcome; D014945:Wound Healing / Q000528:radiation effects; D014947:Wounds and Injuries / Q000209:etiology / Q000601:surgery*