Closure of infected sternal wounds with a unilateral rectus abdominis muscle flap in addition to bilateral pectoralis major myocutaneous advancement flaps

We have recently added to our regimen a unilateral rectus abdominis muscle flap to cover the lower sternum and adjacent soft tissues, in addition to b ilateral pectoralis major myocutaneous advancement flaps for closure of inf ected sternal wounds. Twenty patients underwent this procedure for closure of infected sternal wounds after initial debridement at our institutions. T here were no intraoperative deaths in this series, but three patients died of other medical conditions. Two patients developed hematomas and one devel oped recurrent sternal wound infection after surgery; two had superficial w ound infections and five had minor wound problems (i.e., skin edge necrosis ). All surviving patients (17/20, 85%) had healed sternal wounds with norma l chest contour and there were no instances of flap necrosis, sternal wound dehiscence, or abdominal wall hernia during the follow-up (18-60 months). Based upon our experience, we recommend a unilateral rectus abdominis muscl e flap in addition to bilateral pectoralis major myocutaneous advancement f laps for selected patients with infected sternal wounds. This approach prov ides reliable soft tissue coverage with acceptable morbidity and mortality in this high-risk patient population.