The Pectoralis Major Myocutaneous Flap and Omental Transposition for Closure of Infected Median Sternotomy Wounds

Hr, Herrera; Me, Ginsburg

doi:10.1097/00006534-198210000-00009

Cited by 63 publications

(29 citation statements)

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“…Our suggested schema (Table 1) is biased toward maximal utilization of the pectoralis major and rectus abdominis muscles with which we are most familiar. Other rarely chosen alternatives include the latissimus dorsi (16) or external oblique (6) muscles, or omentum which requires a laparatomy (1,3,17).…”

Section: Resultsmentioning

confidence: 99%

Management of the recurrent sternal wound infection

Hallock¹

1995

CAN J PLAST SURG

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GG Hallock. Management of the recurrent sternal wound infection. Can J Plast Surg 1995;3(3):127-132. After adequate sternal debridement or resection for the treatment of a sternal wound infection, muscle flap obliteration of the resulting void has become an accepted standard. Unfortunately, recurrence is not an inconsequential risk as evidenced in six (20.7%) of our patients over the last 10 years. Two of these patients required a second muscle flap transfer before obtaining a healed wound. Since the available regional options for appropriate vascularized flaps is limited, especially with the increased frequency in use of the internal mammary artery for coronary artery bypass grafting, great care must be observed in the selection process not just for closure of the initial wound, but in anticipation of untoward sequela. A schema prioritizing alternatives has been established, so as to maximize the benefit of our workhorse flaps, the pectoralis major or rectus abdominis muscles. Key Words: Median sternotomy, Muscle flaps, Sternal wound infectionTraitement de l'infection récidivante d'une plaie au sternum RÉSUMÉ: Après un débridement ou une résection sternale adéquate pour le traitement d'une infection de plaie sternale, l'oblitération du lambeau musculaire est devenue une norme acceptée. Malheureusement, la récurrence n'est pas un risque bénin, comme en font foi six de nos cas (20,7 %) échelonnés sur dix ans. Deux de ces patients ont nécessité un nouveau lambeau musculaire pour obtenir une cicatrisation. Étant donné que le choix de lambeaux adéquatement vascularisés est limité, et particulièrement compte tenu de la fréquence accrue d'utilisation de l'artère mammaire interne pour les interventions de chirurgie cardiaque, il faut choisir l'intervention avec grand soin, non seulement pour ce qui est de la fermeture de la plaie initiale, mais pour prévenir toute séquelle indésirable. Un schéma établissant des solutions de rechange a été mis sur pied pour maximiser les avantages de nos principaux lambeaux, le grand pectoral et le grand droit de l'abdomen.The incidence of sternal wound infection following cardiothoracic surgery is relatively miniscule, and certainly not in excess of the general rate of wound infection after most elective operations (1). Unfortunately, for those so afflicted, this can be a devastating problem due to risks of generalized sepsis, uncontrolled hemorrhage or thrombosis, or seeding of prosthetic devices (2,3). Survival has increased over the years paralleling the evolution in treatment from open dressings, closed methods with suction

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Section: Resultsmentioning

confidence: 99%

Management of the recurrent sternal wound infection

Hallock¹

1995

CAN J PLAST SURG

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“…The omental flap is reported as another alternative. 17 However, it has several major disadvantages. A laparotomy is required for flap harvest in an already high-risk patient population, thus resulting in additional morbidity and an increased risk of mortality.…”

Section: Discussion Superiorly Based Vram Flapsmentioning

confidence: 99%

Versatility of vertical rectus abdominis musculocutaneous flaps

et al. 2006

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The purpose of the study was to demonstrate a variety of indications for the vertical rectus abdominis musculocutaneous (VRAM) flap with respect to donor-site morbidity and alternative procedures. Fifteen VRAM flaps were performed in 15 patients during a 4-year period. The average age of patients was 58 years (range, 34-76 years). Inferiorly based VRAM flaps were used for defect coverage after tumor resection and for penile reconstruction in 7 cases. Superiorly based VRAM flaps were performed in 7 cases for reconstruction of osteocutaneous defects following sternal osteomyelitis and tumor resection. Arterial and venous "supercharging" was necessary in one case. One free VRAM flap was performed in a patient suffering from an osteocutaneous defect after resection of a malignant melanoma metastasis with infiltration of the brain and skull. The reconstructive goals were achieved in all cases using VRAM flap procedures. No total flap loss occurred. Minor complications as well as abdominal wall bulging and hernias were observed in four cases. The pedicled VRAM flap provides a reliable tool for coverage of large soft-tissue defects of the chest wall, groin, hip, and perineum even in a high-risk population, in which a safe and fast forward flap procedure is the primary reconstructive goal. Arterial and/or venous supercharging may be necessary, particularly in superiorly based VRAM flaps. An inferiorly based VRAM flap is a reliable tool for phalloplasty under special circumstances. The indication for free VRAM flaps is given in rare clinical situations. Stabilization of the donor site using artificial mesh is highly recommended.

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“…If bone is not exposed, local skin flaps by themselves might work [13]. Other more complicated alternatives are a segmental pectoralis major muscle flap based on internal mammary perforators [4,12], bipedicled combined pectoralis major and inferiorbased rectus abdominis flap [16,17], omentum [3,8], or a free flap [16]. The ability to use the rectus abdominis muscle in spite of an ipsilateral subcostal scar is an attractive, simpler concept.…”

Section: Discussionmentioning

confidence: 99%

“…Due to its proximity and large surface area, the pectoralis major muscle has had a dominant role in closing extensive sternal defects [8,9,11,12,14]. Even when bilateral pectoralis flaps or the latissimus dorsi muscle [16,19] are used, the lower third of the wound over the anterior diaphragm is often tenuously covered, if at all [4,16,17].…”

Section: Introductionmentioning

confidence: 99%

“…Even when bilateral pectoralis flaps or the latissimus dorsi muscle [16,19] are used, the lower third of the wound over the anterior diaphragm is often tenuously covered, if at all [4,16,17]. Alternative solitary flaps that are available for filling the entire wound include the omentum [3,8,15] or even free flaps [16], but all have an inherent complexity and limitations.…”

Section: Introductionmentioning

confidence: 99%

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Sternal wound closure using the rectus abdominis muscle in spite of a subcostal scar

Hallock

2002

Eur J Plast Surg

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Although median sternotomy wound complications are uncommon, the consequences can be potentially devastating. The superior-based rectus abdominis muscle is an important complementary flap that is especially valuable to obliterate the inferior aspect of these extensive wounds. This is not usually possible with the workhorse pectoralis major muscle alone. The increasing use of the internal mammary arteries as a bypass conduit or a prior subcostal scar may devascularize the rectus abdominis muscle and, thus, are relative contraindications for selecting this muscle. However, depending on the size of the defect and location of the subcostal scar, the upper portion of the rectus abdominis muscle may, at least, still be a viable and important alternative flap.

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The Pectoralis Major Myocutaneous Flap and Omental Transposition for Closure of Infected Median Sternotomy Wounds

Cited by 63 publications

References 0 publications

Management of the recurrent sternal wound infection

Management of the recurrent sternal wound infection

Versatility of vertical rectus abdominis musculocutaneous flaps

Sternal wound closure using the rectus abdominis muscle in spite of a subcostal scar

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