VASCULARIZED MUSCLE FLAPS AND REOPERATIVE APPROACH FOR COMPLICATED, DEHISCED STERNAL WOUNDS IN CHILDREN

Vascularized muscle flaps for treatment of mediastinitis and sternal w ound dehiscence have become standard treatment practice, but triple-mu scle flap reconstruction is reserved for the more complex wounds. The incisional approach for reoperation in such patients is controversial. We report an extremely ill infant, born at 38 weeks gestational age, who underwent an arterial switch procedure for transposition of the gr eat arteries at 12 days of age. Sternal wound infection, dehiscence, m ediastinitis, and extensive wound necrosis complicated the postoperati ve course. The cultured organism Enterobacter is a relatively rare cau se for median sternotomy wound infection and was associated with massi ve postoperative hemorrhage. The infant underwent multiple debridement s and at 2 months of age had reconstructive surgery with bilateral pec toralis major muscle advancement flaps combined with a rectus abdomini s muscle flap. Three months postreconstruction the infant required reo peration to correct a stenosis at the site of the pulmonary artery ana stomosis. This surgery was carried out through the previous median ste rnotomy scar because it was the safest, most direct approach and would also limit additional scarring. Long-term follow-up at 2 years of age shows a well-developed young boy with no limitations in growth and ac tivity.