Sternotomy wounds: rectus flap versus modified pectoral reconstruction.

BACKGROUND: Infected sternotomy wounds occur in 0.5 to 8.4 percent of open heart operations. They are complex problems, with a mortality rate of 8.1 to 14.8 percent despite flap closure. For closure, the pectoralis major flap has had considerable success. However, in providing coverage to the lower third of the sternum, it may be deficient. Modifications to improve closure have included a rectus flap or an anterior rectus fascia extension to the pectoralis flap.

METHODS: This retrospective study of 130 consecutive sternotomy wounds compares 41 bilateral pectoralis major muscle flaps with a modified anterior rectus fascia extension against 56 rectus abdominis muscle flaps alone in addressing the lower third of the sternum following dehiscence.

RESULTS: Pectoralis flaps with rectus fascia extension and rectus flaps have similar success, postoperative course, and morbidity and mortality rates. The pectoralis flaps with rectus fascia extensions prevented superior dehiscence, but this modification does not eliminate dehiscence of the distal third of the sternum.

CONCLUSIONS: The rectus muscle alone proved superior in coverage to the inferior sternum. Sternal wounds should be covered preferentially by a pectoralis flap to cover a superior infection and by a rectus flap if the dehiscence is localized to the distal third.