BIPEDICLE MUSCLE FLAPS IN STERNAL WOUND REPAIR

Infection following median sternotomy is a devastating and potentially life-threatening complication. The use of muscle flaps has become wid ely accepted as a mainstay in the treatment of these problems. We have previously described our successful use of a bipedicle muscle flap fo r reconstruction of sternal defects in 16 patients. In this paper, we describe follow-up in those patients as well as an evaluation of this procedure in an additional 26 patients. All records of those patients who had sternal reconstruction using the bipedicle pectoralis major-re ctus abdominis flap were reviewed. Factors analyzed included the ripe of cardiac surgery, associated conditions, complications of surgery, a nd outcome. There were 42 patients in this group from 1989 to 1996. Th ere were a variety of cardiac procedures represented. Associated condi tions included diabetes, chronic hypertension, prolonged postcardiotom y hypotension, prior radiation therapy, pulmonary failure, and steroid use. There were no deaths in this series. There was one flap failure, one persistent infection, one pneumothorax, and one hernia in this se ries. Three patients developed hematomas after surgery. The most commo n complication was a skin slough, which occurred in nine patients. Thi s technique provides a large flap that can fill the entire mediastinum . The dissection is rapid, and the complication rate compares favorabl y to that of other methods.