TREATMENT OF INFECTED MEDIAN STERNOTOMY WOUNDS WITH A MYOCUTANEOUS LATISSIMUS-DORSI MUSCLE FLAP

Infected sternotomy wounds, particularly if accompanied by osteomyelit is, mediastinitis or pericarditis, are associated with significant mor bidity, prolonged hospitalization and a mortality of up to 50%. Until the introduction of muscle flaps, the therapy of choice was debridemen t and open granulation or catheter irrigation. From 1994 to 1996, 9 pa tients with infected median sternotomy wounds were treated with a sing le-stage radical debridement and wound closure with a pedicled myocuta neous latissimus dorsi muscle flap (LDM). One patient received, in add ition, a rectus abdominis muscle turnover flap. Healing was uneventful in all cases, with no respiratory complications or chest-wall instabi lity. Shoulder strength was also unaffected. Functional and aesthetic outcome was good. The LDM provides a safe flap with little donor site morbidity. Compared to the most local muscle flaps, an intact IMA is n ot required. At the same time, length and cost of hospital stay are de creased.