title: Early and long-term results of pectoralis muscle flap reconstruction versus sternal rewiring following failed sternal closure.
abstract: OBJECTIVE
  The aim of the study was to compare early and long-term results of pectoralis muscle flap reconstruction with those of sternal rewiring following failed sternal closure. Primary outcomes of the study were survival and failure rate. Respiratory function, chronic pain and quality of life were also evaluated.
  
  
  METHODS
  In a propensity-score matching analysis, of 94 patients who underwent sternal reconstruction, 40 were selected; 20 underwent sternal reconstruction with bilateral pectoralis muscle flaps (Group 1) and 20 underwent sternal rewiring (Group 2). Survival and failure rates were evaluated by in-hospital records and at follow-up. Respiratory function measures, including vital capacity (VC), were evaluated both by spirometry and computed tomography (CT) volumetry. Chronic pain was evaluated by the visual analogue pain scale.
  
  
  RESULTS
  At 85 ± 24 months of follow-up, survival and procedure failure were 95 and 90% in Group 1 and 60 and 55% in Group 2, respectively (P < 0.01, for both comparisons). Based on CT-scan volumetry, in Group 1, severe non-union and hemisternal paradoxical movement occurred less frequently (2 vs 7, P = 0.01). At spirometry assessment, postoperative VC was greater in Group 1 (3220 ± 290 vs 3070 ± 290 ml, P = 0.04). The same trend was detected by CT-scan in-expiratory measures (4034 ± 1800 vs 3182 ± 862 mm(3), P < 0.05). Correspondingly, in Group 1, less patients presented in NYHA Class III (P < 0.05), and both chronic persistent pain score and physical health quality-of-life score were significantly better in the same group.
  
  
  CONCLUSIONS
  In our study, muscle flap reconstruction guaranteed better early and late-term results as shown by lower rates of mortality, procedure failure and hemisternum stability. Moreover, Group 1 patients had greater postoperative VC, lower NYHA class and better quality of life. These results suggest that, in patients with multiple bone fracture, the rewiring approach does not promote physiological bone consolidation, whereas the muscle flap reconstruction can assure more physiological ventilatory dynamics.
authors.affiliation: Division of Cardiac Surgery, Fondazione Policlinico Tor Vergata, Tor Vergata University of Rome, Rome, Italy. zeitani@hotmail.com
authors.forename: Jacob
authors.initials: J
authors.lastname: Zeitani
authors.forename: Eugenio
authors.initials: E
authors.lastname: Pompeo
authors.forename: Paolo
authors.initials: P
authors.lastname: Nardi
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Sergiacomi
authors.forename: Mattia
authors.initials: M
authors.lastname: Scognamiglio
authors.forename: Giovanni
authors.initials: G
authors.lastname: Chiariello
authors.forename: Costantino
authors.initials: C
authors.lastname: Del Giudice
authors.forename: Chiara
authors.initials: C
authors.lastname: Arganini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Simonetti
authors.forename: Luigi
authors.initials: L
authors.lastname: Chiariello
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010369:Pectoralis Muscles / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery; D057216:Propensity Score; D019651:Plastic Surgery Procedures / Q000379:methods*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013249:Sternum / Q000601:surgery*; D013524:Surgical Flaps; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Pectoralis muscles; Respiratory function; Sternal wound dehiscence