Selected Methods of the Chest Wall Reconstruction for Sternal Dehiscence after Median Sternotomy

• Authors: Edward Lewandowicz , Aleksandra Iljin , Anna Kasielska-Trojan , Marta Fijałkowska , Bogusław Antoszewski
• Languages of publication: EN

Abstracts

EN

Dehiscence of a median sternotomy wound is a potentially devastating and life-threatening complication of cardiac procedures.Depending on the localization, extensiveness, and profoundness of the defect a variety of muscle flaps may be used to cover the frontal mediastinum, in particular: pectoralis major, rectus abdominisor latissimus dorsi. In spite of several options for restoration of sternal integrity we cannot avoid following serious local complications increasing patients morbidity. The aim of this paper is to report a method of sternal dehiscence management. Surgical technique and its results are presented on the example of two patients treated in Plastic, Reconstructive and Aesthetic Surgery Clinic, Medical University in Łódź because of sternal dehiscence after cardiovascular procedure with sternotomy. Our experience indicates that modified bilateral pectoralis major flap seems to be effective surgical method of sternal dehiscence treatment. Also it is worth to remember that surgical procedure in this complication should be performed as soon as possible to decrease patient’s disability and to avoid following complications

Keywords

EN

sternum; complication; pectoralis major flap

• Publisher: De Gruyter Open
• Journal: Polish Journal of Surgery
• Year: 2015
• Volume: 86
• Issue: 5
• Pages: 230-234

Dates

published

1 - 5 - 2014

online

1 - 7 - 2014

received

8 - 6 - 2013

Contributors

author

Edward Lewandowicz

• (Department of Plastic, Reconstructive and Aesthetic Surgery, Institute of Surgery, Medical University in Łódź, Kierownik: prof. dr hab. B. Antoszewski

author

Aleksandra Iljin

• (Department of Plastic, Reconstructive and Aesthetic Surgery, Institute of Surgery, Medical University in Łódź, Kierownik: prof. dr hab. B. Antoszewski

author

Anna Kasielska-Trojan

• (Department of Plastic, Reconstructive and Aesthetic Surgery, Institute of Surgery, Medical University in Łódź, Kierownik: prof. dr hab. B. Antoszewski

author

Marta Fijałkowska

• (Department of Plastic, Reconstructive and Aesthetic Surgery, Institute of Surgery, Medical University in Łódź, Kierownik: prof. dr hab. B. Antoszewski

author

Bogusław Antoszewski

• (Department of Plastic, Reconstructive and Aesthetic Surgery, Institute of Surgery, Medical University in Łódź, Kierownik: prof. dr hab. B. Antoszewski

References

• 1. Neaman KC, Blount AL, Kim JA et al.: Prophylactic sternal plating with pectoralis advancement flaps after sternotomy in patients with a history of chest irradiation. Interact Cardiovasc Thorac Surg 2011; 12: 355-58.[WoS]
• 2. Telfer JR, Chapple DC, Powell BW: Metastatic colonic adenocarcinoma in a pedicled omental flap used for sternal reconstruction: a case report. Br J Plast Surg 1996; 49: 67-69.
• 3. Landes G, Harris PG, Sampalis JS et al.: Outcomes in the management of sternal dehiscence by plastic surgery: a ten-year review in one university center. Ann Plast Surg 2007; 59: 659-66.
• 4. Salazard B, Niddam J, Ghez O et al.: Vacuumassisted closure in the treatment of poststernotomy mediastinitis in the paediatric patient. J Plast Reconstr Aesthet Surg 2008; 61: 302-05.[WoS]
• 5. Song DH, Lohman RF, Renucci JD et al.: Primary sternal plating in high-risk patients prevents mediastinitis. Eur J Cardiothorac Surg 2004; 26: 367-72.[Crossref][PubMed]
• 6. Lusini M, Di Martino A, Spadaccio C et al.: Resynthesis of sternal dehiscence with autologous bone graft and autologous platelet gel. J Wound Care 2012; 21: 76-77.
• 7. Schols RM, Lauwers TM, Geskes GG, van der Hulst RR: Deep sternal wound infection after open heart surgery: current treatment insights. A retrospective study of 36 cases. Eur J Plast Surg 2011; 34: 487-92.[Crossref]
• 8. Dickie SR, Dorafshar AH, Song DH: Definitive closure of the infected median sternotomy wound: a treatment algorithm utilizing vacuum-assisted closure followed by rigid plate fixation. Ann Plast Surg 2006; 56: 680-85.[PubMed]
• 9. Riess FC, Awwad N, Hoffmann B et al.: A steel band in addition to 8 wire cerclages reduces the risk of sternal dehiscence after median sternotomy. Heart Surg Forum 2004; 7: 387-92.
• 10. Perkins DJ, Hunt JA, Pennington DG, Stern HS: Secondary sternal repair following median sternotomy using interosseous absorbable sutures and pectoralis major myocutaneous advancement flaps. Br J Plast Surg 1996; 49: 214-19.
• 11. Sahasrabudhe P, Jagtap R, Waykole P et al.: Our experience with pectoralis major flap for management of sternal dehiscence: A review of 25 cases. Indian J Plast Surg 2011; 44: 405-13.
• 12. Phan TQ, Theodorou P, Depner C et al.: Failure of Secondary Wound Closure After Sternal Wound Infection Following Failed Initial Operative Treatment: Causes and Treatment. Ann Plast Surg 2013; 70: 216-21.[PubMed]
• 13. Clarkson JH, Probst F, Niranjan NS et al.: Our experience using the vertical rectus abdominis muscle flap for reconstruction in 12 patients with dehiscence of a median sternotomy wound and mediastinitis. Scand J Plast Reconstr Surg Hand Surg 2003; 37: 266-71.
• 14. Dejesus RA , Paletta JD, Dabb RW : Reconstruction of the median sternotomy wound dehiscence using the latissimus dorsi myocutaneous flap. J Cardiovasc Surg 2001; 42: 359-64.
• 15. Chou EK, Tai YT, Chen HC, Chen KT: Simple and reliable way in sternum wound coverage-- tripedicle pectoralis major musculocutaneous flap. Microsurgery 2008; 28: 441-46.[Crossref][WoS][PubMed]
• 16. Brandt C, Alvarez J: First-line treatment of deep sternal infection by a plastic surgical approach: superior results compared with conventional cardiac surgical orthodoxy. Plast Reconstr Surg 2002; 109: 2231-37.[PubMed][Crossref]
• 17. de Fontaine S, Devos S, Goldschmidt D: Reduction mammaplasty combined with pectoralis major muscle flaps for median sternotomy wound closure. Br J Plast Surg 1996; 49: 220-22.
• 18. Roshan A, Kotwal A, Riaz M, Stanley PR: Sternal wound dehiscence complicated by macromastia: report of two cases with discussion of literature. J Plast Reconstr Aesthet Surg 2009; 62: e362-64.[WoS]
• 19. Weinzweig N, Yetman R: Transposition of the greater omentum for recalcitrant median sternotomy wound infections. Ann Plast Surg 1995; 34: 471-77.[PubMed]
• 20. Cabbabe EB, Cabbabe SW: Immediate versus delayed one-stage sternal debridement and pectoralis muscle flap reconstruction of deep sternal wound infections. Plast Reconstr Surg 2009; 123: 1490-94.[Crossref][PubMed][WoS]
• 21. Wong CH, Senewiratne S, Garlick B, Mullany D: Two-stage management of sternal wound infection using bilateral pectoralis major advancement flap. Eur J Cardiothorac Surg 2006; 30: 148-52. [PubMed][Crossref]

Identifiers

DOI

10.2478/pjs-2014-0040