Prophylactic sternal plating with pectoralis advancement flaps after sternotomy in patients with a history of chest irradiation.
Deep sternal infections secondary to bony instability and malunion, can result in mediastinitis. Previous authors have described the use of prophylactic rigid plate fixation in high-risk patients. The purpose of our study is to review the use of prophylactic sternal platting with pectoralis advancement flaps in high-risk patients with a history of chest irradiation. Fourteen patients (July 2003-September 2008) with a history of chest irradiation who underwent a median sternotomy followed by prophylactic rigid plate fixation of the sternum were reviewed. Breast cancer was the most common etiology of chest irradiation (n=11, 78%). The average EuroSCORE was 24.06% with 72% of patients having a preoperative New York Heart Association (NYHA) class≥III. There were no episodes of sternal non-union, mediastinitis or death. Follow-up was 100% with a 0% 30-day and a 7.1% one-year mortality rate (non-cardiac). A comparison between mean preoperative left ventricular ejection fraction (LVEF) (49.6%) and postoperative LVEF (59.7%) was statistically significant (P<0.0001). All living patients currently maintain a NYHA class I/II. Prophylactic rigid plate fixation and pectoralis flap coverage decreases the risk of developing sternal dehiscence and postoperative wound complications and should therefore be considered in high-risk patients with a history of chest irradiation.
Grand Rapids Medical Education Partners, Michigan State University Plastic Surgery Residency, Grand Rapids, MI, USA.
Keith C
KC
Neaman
Andrew L
AL
Blount
John A
JA
Kim
John D
JD
Renucci
Robert L
RL
Hooker
D000368:Aged; D001860:Bone Plates; D006348:Cardiac Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000209:etiology / Q000517:prevention & control; D008824:Michigan; D010369:Pectoralis Muscles / Q000601:surgery*; D011878:Radiotherapy / Q000009:adverse effects; D056346:Sternotomy / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D013524:Surgical Flaps / Q000009:adverse effects; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control; D035423:Thoracic Cavity / Q000528:radiation effects*; D013997:Time Factors; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality