title: Infraareolar pectoralis major myocutaneous island flap as treatment of first choice for deep sternal wound infection.
abstract: Deep sternal wound infection (DSWI) is a grave complication of median sternotomy, associated with high morbidity, mortality and escalating treatment costs. There is general consensus that optimal treatment comprises radical debridement followed by coverage with a vascularised flap. However, there is ongoing debate regarding the ideal operative procedure. We present our experience with the infraareolar pectoralis major island myocutaneous flap (PEC-MI flap) as treatment of first choice in DSWI. Following a retrospective chart review, data pertaining to patient demographics, type of cardiac surgery performed, prevalence of known DSWI risk factors, identified pathogens, duration of surgery, flap-related complications, duration of hospital stay and antibiotic therapy, as well as mortality were noted. Additionally, we describe the operative technique and review the relevant literature. Twenty-five patients underwent coverage with the PEC-MI flap in our department. The average age was 69.2 years. Nineteen patients underwent coronary artery bypass surgery, 10 valve replacement, two aortic replacement surgery and one pericardiectomy. In six cases, no internal mammary artery was used in cardiac surgery, in 11 cases one and in seven cases both internal mammary arteries were used. The average duration of surgery was 154.2 min and the average hospital stay was 28.4 days. Complications which required revision surgery were haematoma in three cases, one wound dehiscence and one recurrent infection. Two cases required coverage with an additional regional flap. The PEC-MI flap has been used as flap of first choice in our clinic for treatment of DSWI. It is sufficient to raise the flap unilaterally, and it does not require skin grafting. The combination of immunocompetent bulky muscle tissue used to obliterate the sternal cavity and the large skin paddle enabling a low-tension skin closure allows reliable and efficient treatment of this severe complication.
authors.affiliation: Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Hugstetterstrasse 55, 79106 Freiburg, Germany. filip.simunovic@uniklinik-freiburg.de
authors.forename: Filip
authors.initials: F
authors.lastname: Simunovic
authors.forename: Georgios
authors.initials: G
authors.lastname: Koulaxouzidis
authors.forename: G Bjoern
authors.initials: GB
authors.lastname: Stark
authors.forename: Nestor
authors.initials: N
authors.lastname: Torio-Padron
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010369:Pectoralis Muscles / Q000098:blood supply / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D056346:Sternotomy / Q000009:adverse effects* / Q000379:methods; D013524:Surgical Flaps / Q000098:blood supply*; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000601:surgery*; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology