MEDIAN STERNOTOMY WOUND COMPLICATION - THE EFFECT OF RECONSTRUCTION ON LUNG-FUNCTION

The objective of the study was to evaluate the lung function of patien ts with median sternotomy wound complication during the early postmedi an sternotomy period and to compare the long-term pulmonary effects of reconstruction using pectoralis major and rectus abdominis muscle fla ps. The percentage of predicted, standardized forced vital capacity (F VC); the standardized forced expiratory volume in 1 second (FEV1), and FEV1/FVC ratios of 45 patients with a median sternotomy wound complic ation were evaluated before and at a mean time of 10.6 months after wo und reconstruction. Both mean FVC and FEV1 increased after wound revis ion compared with the prereconstruction results (8.4% and 9.2% increas e, respectively). Patients with painful chest wall movement had the wo rst (60%) mean FVC and FEV, before reconstruction when compared with a nonpainful complication. Reconstruction with a muscle flap was follow ed by an increase of 8.6% and 7.3% in FEV1 and FVC1 respectively, from prereconstruction results. However, long-term results indicate that t hese patients have a mild, restrictive impairment of their lung functi on tests (LFTs), with about 80% of the predicted FVC and FEV1. Among t he muscle flaps, the best improvement and best longterm LFT results we re after sternectomy and reconstruction with a pectoralis major muscle flap as compared with a rectus abdominis muscle flap, Sternectomy and reconstruction with a muscle flap is a well-tolerated procedure assoc iated with improvement of lung function compared with prereconstructio n values. A pectoralis major muscle flap should be the first choice fo r muscle flap reconstruction while a rectus abdominis muscle flap shou ld be reserved only for patients with good LFTs before reconstruction.