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J Thorac Cardiovasc Surg 2008;136:618-622
© 2008 The American Association for Thoracic Surgery

General Thoracic Surgery

Pectoralis major–rectus abdominis bipedicled muscle flap in the treatment of poststernotomy mediastinitis

Tai Suk Roh, MD, Won Jai Lee, MD, PhD*, Dae Hyun Lew, MD, Kwan Chul Tark, MD

Institute for Human Tissue Restoration, Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea

Received for publication October 13, 2007; revisions received December 23, 2007; accepted for publication January 22, 2008.

* Address for reprints: Won-Jai Lee, MD, Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, 134 Shinchon-Dong, Seodaemun-Gu, Seoul, Korea. (Email: pswjlee{at}yumc.yonsei.ac.kr).

Objectives: Although the incidence of infected sternotomy wounds after median sternotomy for cardiovascular surgery is relatively low (0.5% to 5%), it is associated with significant morbidity and a long period of treatment. Today, muscle flaps, such as the pectoralis major or the rectus abdominis, are widely accepted as a mainstay of reconstructive options. Each method carries unavoidable limitations and setbacks of its own. To overcome the disadvantages of the pectoralis muscle and rectus abdominis muscle flaps, we designed and performed a pectoralis major–rectus abdominis muscle bipedicled flap for the coverage of sternal defects.

Methods: The pectoralis major–rectus abdominis bipedicled flap was elevated as a single unit, preserving the thoracoepigastric fascia in continuity with the rectus muscle and its anterior fascia. The method was used in 27 patients with postoperative mediastinitis during a 5-year period.

Results: The bipedicled flap could fill the defect with sufficient volume, not only in the upper two thirds but also in the lower one third of the sternum. Recurrent uncontrolled infection developed in 11% of all cases, and upper abdominal fascial attenuation was observed in 1 patient. There were no surgical intervention–related complications or deaths.

Conclusions: We conclude that pectoralis major–rectus abdominis bipedicled flap is a practical and efficacious method in the reconstruction of the anterior chest wall defect caused by poststernotomy mediastinitis. It not only provides sufficient volume to fill the entire mediastinum but also affords resolution of the infected wound with favorable outcomes comparable with those of other methods.

Abbreviations and Acronyms CABG = coronary artery bypass grafting; MRSA = methicillin-resistant Staphylococcus aureus






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