MUSCLE FLAP RECONSTRUCTION OF PEDIATRIC POSTSTERNOTOMY WOUND INFECTIONS

Sternal wound infections following pediatric open-heart procedures occ ur infrequently. Four of our last 600 consecutive pediatric open-heart median sternotomies (1991 to 1996) required muscle flap reconstructio n for treatment of deeply infected sternotomy wounds. Risk factors inc luded multiple sternotomies, previous superficial infection, and immun ocompromised states, Two patients were closed with bilateral pectorali s muscle flaps. The 2 other patients were closed with vertical rectus abdominis muscle flaps; 1 including an attached skin paddle. While the pectoralis major muscle flap is the first flap of choice utilized in adult patients, in pediatric patients a different hierarchy of flap se lection is often necessary. The chest wall often has multiple scars fr om previous procedures, limiting use of the pectoralis muscle. In smal l infants the pectoralis muscle can be thin and inadequate for large s ternal defects, All patients achieved healed wounds, Muscle flap recon struction of pediatric sternal wounds can be an effective one-stage tr eatment for deep sternal wound infections with sternal instability.