PECTORALIS MAJOR MUSCLE TRANSPOSITION FOR TREATMENT OF INFECTED MEDIAN STERNOTOMY WOUNDS

Median sternotomy, currently the standard incision in open heart proce dures, is rarely complicated by wound infection, but when present, it is associated with a high morbidity and mortality. Adequate treatment can be provided by means of transposition of the pectoralis major musc le, After thorough sternal wound debridement the muscle, based on the thoraco-acromial pedicle, is transposed into the defect. From Septembe r 1986 until December 1992 14 patients (mean age 67 years) with sterna l infection were treated using this technique. Mean hospital stay afte r operation was 23 days; mean follow-up was 24 months, In 10 patients (72%) a successful treatment, i.e. a permanently cured infection, was achieved. Three patients (21%) developed a recurrence; one of them die d during follow-up as a consequence of cardiac failure, the other two underwent reoperation and healing occurred at a later stage. In one pa tient (who died of a unknown cause 2 months after muscle transposition ) the result was classified as unknown. In conclusion, transposition o f the pectoralis major muscle is an adequate treatment for severe ster nal infections. In comparison with conservative methods, mortality and morbidity can be reduced and hospital stay can be shortened.