Functional impairment after treatment with pectoral muscle flaps because of deep sternal wound infection

Eriksson, Jenny; Huljebrant, Inger; Nettelblad, Hans; Svedjeholm, Rolf

doi:10.3109/14017431.2011.563318

Cited by 17 publications

(12 citation statements)

References 29 publications

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“…They found significant longterm disability in one third of patients. Sternum had not been closed in half the patients after debridement and the fact that the function of right arm and shoulder was affected more often despite the majority of procedures being left sided suggests that loss of skeletal continuity of the chest wall was more disabling than loss of pectoral muscle function [ 36 ]. Longstanding sternal non-union of 5 to 48 months was treated by pectoralis major muscle flap reconstruction in 24 patients over a 15 years period by Cabbabe and colleagues who reported dramatic improvement in symptoms of pain, popping and grinding [ 37 ].…”

Section: Reviewmentioning

confidence: 99%

Sternal reconstruction after post-sternotomy mediastinitis

Kaul

2017

J Cardiothorac Surg

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BackgroundDeep sternal wound complications are uncommon after cardiac surgery. They comprise sternal dehiscence, deep sternal wound infections and mediastinitis, which will be treated as varying expressions of a singular pathology for reasons explained in the text.Methodology and reviewThis article reviews the definition, prevalence, risk factors, prevention, diagnosis, microbiology and management of deep sternal wound infections and mediastinitis after cardiac surgery. The role of negative pressure wound therapy and initial and delayed surgical management is discussed with special emphasis on plastic techniques with muscle and omental flaps. Recent advances in reconstructive surgery are presented.ConclusionsDeep sternal wound complications no longer spell debilitating morbidity and high mortality. Better understanding of risk factors that predispose to deep sternal wound complications and general improvement in theatre protocols for asepsis have dramatically reduced the incidence of deep sternal wound complications. Negative pressure wound therapy and appropriately timed and staged muscle or omental flap reconstruction have transformed the outcomes once these complications occur.

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Section: Reviewmentioning

confidence: 99%

Sternal reconstruction after post-sternotomy mediastinitis

Kaul

2017

J Cardiothorac Surg

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“…A study published in 2011 reported the long‐term complications in 19 patients after using the bilateral pectoralis major muscle flap for sternotomy closure. After a mean follow up of almost 6 years, more than half of these patients reported an unstable chest, two‐thirds of them reported difficulty in daily activities, and 37% reported problems with dressing· In that same study, 32% of patients preferred an alternative treatment at the time of flap harvesting, to avoid chest instability, even if such treatment could delay the healing process.…”

Section: Discussionmentioning

confidence: 99%

Unilateral pectoralis major muscle flap for the treatment of sternal wounds due to Ludwig's angina

Neto

Coltro

Horácio

et al. 2017

International Wound Journal

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Necrotising descending mediastinitis may rarely originate from Ludwig's angina, which is an infection of the submandibular space. The use of the bilateral pectoralis major muscle flap for the treatment of sternal wound dehiscence is common, but reports of the unilateral application of this flap are scarce. This study aims to report the use of the unilateral pectoralis major muscle flap for the treatment of sternotomy dehiscence in a patient with mediastinitis due to Ludwig's angina. A 21-year-old male patient underwent an exploratory cervicotomy and median sternotomy for drainage of a submandibular infection that extended to the anterior, retropharyngeal and mediastinal cervical spaces. The patient had dehiscence of the sternal wound, and the unilateral pectoralis major muscle flap was used for reconstruction of the defect. This flap was able to completely cover the area of dehiscence of the sternotomy, and the patient presented a good postoperative evolution, without complications. The reconstruction technique using the unilateral pectoralis major muscle flap was considered a good option for the treatment of sternotomy dehiscence. It is an adjuvant method in the treatment of infections such as mediastinitis and osteomyelitis of the sternum secondary to Ludwig's angina, allowing a stable coverage of the sternum.

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“…The flaps used in sternal reconstruction include pectoralis major muscle flap, rectus abdominis muscle or musculocutaneous flap, omentum, latissimus dorsi muscle or musculocutaneous flap, as well as their combination [15], and more recently a deep superior epigastric perforator (DSEP) flap [16]. Many of these options do not cover the entire length of the sternal defect or are associated with donor site morbidity and multiple potential complications including functional disability, hernias, seromas and pain [1,3,8,10,[17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

“…The operation is brief and the muscles are easy to dissect. However, dividing the muscle's humeral insertion may lead to a functional defect[17,20,31]. The advancement flaps may not reach sufficiently to cover the defects in the most caudal third of the sternum.…”

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confidence: 99%

Modified internal mammary artery perforator flap in treatment of sternal wound complications

Myllykangas

Mustonen

Halonen

et al. 2018

Scandinavian Cardiovascular Journal

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Objectivs There are multiple treatment strategies and flap options to cover defects after deep sternal wound infections and other similar sternal defects. The choice of flap is made according to surgeons' preferences and the size and location of the defect. Our aim is to introduce a new option to cover these kinds of defects with an internal mammary artery perforator flap combined with a pectoralis major muscle flap mostly raised with a muscle-sparing technique. Design We treated 13 patients with a sternal defect after cardiothoracic operations with this technique between 2010-2016. Ten patients had a deep sternal wound infection, two had an infection of the prosthesis after carotico-subclavian bypass and one had a fragmented sternum. Nine patients were treated with an internal mammary artery perforator fasciocutaneous flap with a muscle-sparing pectoralis major muscle flap and four patients with an internal mammary artery perforator fasciocutaneous flap combined with a right pectoralis major muscle flap. Results Three patients (23%) experienced major complications and four patients (31%) had conservatively treated minor complications. There were no flap losses. Conclusion This combination of flaps is a suitable option for patients with large defects in whom direct skin closure is not possible. It can be utilized for defects comprising the entire vertical length of the sternum. These are local flaps with a short operation time and are therefore most suitable for patients with comorbidities in whom major surgery is not an option.

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Functional impairment after treatment with pectoral muscle flaps because of deep sternal wound infection

Cited by 17 publications

References 29 publications

Sternal reconstruction after post-sternotomy mediastinitis

Sternal reconstruction after post-sternotomy mediastinitis

Unilateral pectoralis major muscle flap for the treatment of sternal wounds due to Ludwig's angina

Modified internal mammary artery perforator flap in treatment of sternal wound complications

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