Objective To investigate surgical strategies using bilateral pectoralis major muscle flaps for the treatment of sternal dehiscence after cardiac surgery. Methods From May 2005 to October 2010，21 patients with sternal dehiscence, sternal osteomyelitis and mediastinitis after cardiac surgery were admitted to Beijing An Zhen Hospital of Capital Medical University. There were 13 male patients and 8 female patients with their age of 53-72 （64.5±7.8） years. There were 19 patients after coronary artery bypass grafting （CABG） and 2 patients after heart valve replacement. The non-viable and necrotic bones were debrided and sternal wires partially or completely removed. The sternal origins of pectoralis major were released on both sides. The pectoralis major muscle flaps were tensionlessly sutured across medially over the sternal defect. Multiple suction drains were placed and removed in due time. The skin was intermittently closed. Results All the pectoralis major muscle flaps lived well after surgery，and all the patients were discharged in 2 weeks after surgery. Twenty patients were discharged with complete wound closure，and 1 patient had wound fistula and infection after removal of suction drains that was healed after another surgery to resect the wound fistula. During 6 month follow-up，sternal wound healed well in all the patients with normal thoracic appearance，and none of the patients had abnormal respiratory movement, infection recurrence or persistent infection. Conclusion Bilateral pectoralis major muscle flap technique is a positive and efficient surgical strategy for the treatment of refractory sternal dehiscence after cardiac surgery.
Citation：
SUN Guanglong,CAO Xiangrong,ZHANG Jianqun.. Bilateral Pectoralis Major Muscle Flaps for the Treatment of Sternal Dehiscence after Cardiac Surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(2): 185-187. doi: 10.7507/1007-4848.20130056
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Copyright © the editorial department of Chinese Journal of Clinical Thoracic and Cardiovascular Surgery of West China Medical Publisher. All rights reserved
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De Feo M， Vicchio M， Nappi G， et al. Role of vacuum in methicillin-resistant deep sternal wound infection. Asian Cardiovasc Thorac Ann， 2010， 18 （4）：360-363.
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Serry C， Bleck PC， Javid H， et al. Sternal wound complications. Management and results. J Thorac Cardiovasc Surg， 1980， 80 （6）：861-867.
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Bhattacharya S， Sau I， Mohan M， et al. Sternal bands for closure of midline sternotomy leads to better wound healing. Asian Cardiovasc Thorac Ann， 2007， 15 （1）：59-63.
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De Brabandere K， Jacobs-Tulleneers-Thevissen D， Czapla J， et al. Negative-pressure wound therapy and laparoscopic omentoplasty for deep sternal wound infections after median sternotomy. Tex Heart Inst J， 2012， 39 （3）：367-371.
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- 1. Saso S， James D， Vecht JA， et al. Effect of skeletonization of the internal thoracic artery for coronary revascularization on the incidence of sternal wound infection. Ann Thorac Surg， 2010， 89 （2）：661-670.
- 2. 白明， 乔群. 组织瓣移植修复治疗胸骨骨髓炎. 中国组织工程研究与临床康复， 2007， 21 （21）：4202-4205.
- 3. Michael GS， Vincent LG， Townsend TR. Mediastinal infection after cardiac surgery. Ann Thorac Surg， 1984， 38 （4）：415-423.
- 4. 贾朝相， 张宝仁， 蔡用之， 等. 心内直视术后切口感染的检测与预防. 中华胸心血管外科杂志， 1990， 6 （2）：68.
- 5. 陈刚， 吕国祯， 陈文庆， 等. 心内直视术后切口感染的处理. 中华胸心血管外科杂志， 1990， 6 （2）：74.
- 6. 刘伟， 余国祥， 樊汉利， 等. 胸大肌瓣移植在慢性胸骨骨髓炎治疗中的应用. 中国胸心血管外科临床杂志， 2002， 9 （4）：285.
- 7. 郑庆林， 薄学荣， 索峰， 等. 冠状动脉搭桥术移植材料的选择. 中国心血管病研究杂志， 2005， 3 （11）：41-42.
- 8. Sofer D， Gurevitch J， Shapira I， et al. Sternal wound infections in patients after coronary artery bypass grafting using bilateral skeletonized internal mammary arteries. Ann Surg， 1999， 229 （4）：585-590.
- 9. De Feo M， Vicchio M， Nappi G， et al. Role of vacuum in methicillin-resistant deep sternal wound infection. Asian Cardiovasc Thorac Ann， 2010， 18 （4）：360-363.
- 10. Serry C， Bleck PC， Javid H， et al. Sternal wound complications. Management and results. J Thorac Cardiovasc Surg， 1980， 80 （6）：861-867.
- 11. Bhattacharya S， Sau I， Mohan M， et al. Sternal bands for closure of midline sternotomy leads to better wound healing. Asian Cardiovasc Thorac Ann， 2007， 15 （1）：59-63.
- 12. De Brabandere K， Jacobs-Tulleneers-Thevissen D， Czapla J， et al. Negative-pressure wound therapy and laparoscopic omentoplasty for deep sternal wound infections after median sternotomy. Tex Heart Inst J， 2012， 39 （3）：367-371.
