Bilateral Pectoral Myocutaneous Advancement Flaps and Anatomic Sternal Wound Reconstruction in Cyanotic Infants with Mediastinitis

Abstract

For postcardiotomy mediastinitis in cyanotic infants we recommend limited debridement and anatomic sternal reconstruction supported by bilateral pectoral myocutaneous advancement flap closure.

Rigid sternal fixation in the management of pediatric postmedian sternotomy mediastinitis: A 20-year study

“…The use of muscle flaps, especially the pectoralis major or the rectus abdominus, 17 to fill mediastinal space has also been well described in pediatric patients. 6,[18][19][20] In these reports, the sternum was debrided, re-sutured, re-wired, or left open and covered with the muscle flaps. More recently, the addition of negative pressure wound pressure therapy [21][22][23][24][25][26][27] 10 muscles as a single myocutaneous unit.…”

Manuseio em um estágio de esternotomia infectada com avanço bilateral de flap miocutâneo do peitoral maior

“…We have used this procedure routinely and systematically [21.26]. Other reports have been published with the same technique and with good results [22][23][24][25]. Unlike the techniques of muscle flaps -translated or rotated with vascular pedicles [11][12] -the technique of advancement of the major pectoralis -bilaterally -is efficient, requires no additional incision and offers full aesthetic and functional recovery of the anterior chest.…”

“…In our institution, since 1986, we began to treat -consecutively -the sternal wound infection (with debridement, wide drainage and immediate closure) with bilateral pectoralis major myocutaneous advancement flap, whose initial results were published in 1993 [21]. This technique has been described, in the same way, by several authors [22.23], even in children previously undergone treatment of congenital heart disease [24,25].…”