Pectoralis Muscle Flap Reconstruction of Pediatric Sternal Wound Infections

Abstract

Sternal wound infection (SWI) is a life-threatening complication in both the pediatric and adult population. The morbidity and mortality of SWIs have decreased with the use of muscle flap reconstruction of the chest wall. Although the pectoralis muscle flap is the most frequently used flap in adults for reconstruction after SWI, its use in children has not been well described. To review current experience with the use of the pectoralis muscle flap in a pediatric population, a retrospective review of 1,200 consecutive median sternotomies occurring at the Children's Hospital of Pittsburgh between 1992 and 1997 was performed. All cases of postoperative SWI were identified, and the operative management was performed by a single surgeon. Reconstruction was performed with the use of unilateral or bilateral pectoral muscle flap advancements. Sternal wound infections developed in nine patients (0.75% incidence). The mean duration from initial sternotomy to the time of presentation of deep SWI was 39.5 days. Eight patients underwent reconstruction using pectoralis muscle advancement flaps. Two patients (25%) were reconstructed with a unilateral pectoralis advancement flap, whereas six patients (75%) required bilateral advancement flaps. One patient was treated with conservative management. The average length of stay after reconstruction was 9 +/- 4 days. Duration of follow-up ranged from 3 to 42 months (mean: 16 +/- 12 months). All reconstructions ultimately resulted in well-healed wounds with satisfactory cosmesis. No developmental or functional deficits have been documented in follow-up visits. Sternal wound infection is a serious postoperative complication of median sternotomy. Aggressive operative management with the use of muscle flap reconstruction has helped to lower the morbidity and mortality of this infection. The successful use of pectoralis muscle flap advancement for functional and esthetic reconstruction of the chest wall in children is described.

Application of Unilateral Pectoralis Major Muscle Flap in the Treatment of Sternal Wound Dehiscence

“…The unilateral pectoralis major muscle flap can also be used in children without functional deficit, with good cosmetic results [ 17 ] . A possible disadvantage of this approach, an opinion shared with Spartalis et al [ 18 ] , would be the limited arc of rotation of the pectoralis major muscle flap to adequately cover the lower third of the sternum defect.…”

The role of the unilateral pectoralis major muscle flap in the treatment of deep sternal wound infection and dehiscence

“…We would like to highlight that unilateral pectoralis major muscle flap can also be used in children and infants, without major functional deficit, and with good cosmetic results. It was observed in the study by Wang et al, in which the authors performed most of the reconstructions using the unilateral technique (20 in 23 cases), 1 and by other studies 10 . In 2018, our group also 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 11 …”

Iliocostalis Muscle Rotational Flap: A Novel Flap for Esophagopleural Fistula Repair

“…A robust, well-vascularized flap is required to provide an airtight layer to close the defect, as they have been shown to improve rates of infection, morbidity, and mortality and minimize fistula recurrence. 3,[6][7][8] Commonly used extrathoracic muscles were compromised in the previous surgical and radiation field, and thus not available as reconstructive options. History of exploratory laparotomy also precluded the use of omentum.…”