Pectoralis major-rectus abdominis bipedicled muscle flap in the treatment of poststernotomy mediastinitis.
OBJECTIVE
Although the incidence of infected sternotomy wounds after median sternotomy for cardiovascular surgery is relatively low (0.5% to 5%), it is associated with significant morbidity and a long period of treatment. Today, muscle flaps, such as the pectoralis major or the rectus abdominis, are widely accepted as a mainstay of reconstructive options. Each method carries unavoidable limitations and setbacks of its own. To overcome the disadvantages of the pectoralis muscle and rectus abdominis muscle flaps, we designed and performed a pectoralis major-rectus abdominis muscle bipedicled flap for the coverage of sternal defects.


METHODS
The pectoralis major-rectus abdominis bipedicled flap was elevated as a single unit, preserving the thoracoepigastric fascia in continuity with the rectus muscle and its anterior fascia. The method was used in 27 patients with postoperative mediastinitis during a 5-year period.


RESULTS
The bipedicled flap could fill the defect with sufficient volume, not only in the upper two thirds but also in the lower one third of the sternum. Recurrent uncontrolled infection developed in 11% of all cases, and upper abdominal fascial attenuation was observed in 1 patient. There were no surgical intervention-related complications or deaths.


CONCLUSIONS
We conclude that pectoralis major-rectus abdominis bipedicled flap is a practical and efficacious method in the reconstruction of the anterior chest wall defect caused by poststernotomy mediastinitis. It not only provides sufficient volume to fill the entire mediastinum but also affords resolution of the infected wound with favorable outcomes comparable with those of other methods.
Roh
Tai Suk
TS
Institute for Human Tissue Restoration, Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
Lee
Won Jai
WJ
Lew
Dae Hyun
DH
Tark
Kwan Chul
KC
D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000601:surgery*; D008875:Middle Aged; D010369:Pectoralis Muscles; D011183:Postoperative Complications; D017568:Rectus Abdominis; D013249:Sternum / Q000601:surgery*; D013524:Surgical Flaps; D019616:Thoracic Surgical Procedures / Q000379:methods; D016896:Treatment Outcome