SINGLE-STAGE MANAGEMENT OF 74 CONSECUTIVE STERNAL WOUND COMPLICATIONSWITH PECTORALIS MAJOR MYOCUTANEOUS ADVANCEMENT FLAPS

The optimal management of sternal wound complications remains controve rsial. Since 1985, we have utilized a combination of immediate, aggres sive debridement with simultaneous repair using bilateral pectoralis m ajor myocutaneous advancement flaps, regardless of the degree of infec tion. As compared with the use of distant pedicled muscle flaps or pec toralis major turnover flaps, the management of complicated sternal wo unds with immediate pectoralis major myocutaneous advancement flaps pr ovides an effective yet simpler, quicker method of management with imp roved aesthetic results. In addition, basing the pectoralis major myoc utaneous flaps on the thoracoacromial arteries eliminates the need for intact internal mammary arteries, valuable since the latter are incre asingly used for coronary grafts. Seventy-four consecutive patients, 1 7 (23 percent) of whom were immunosuppressed heart transplant recipien ts, have been managed with this procedure. There were no intraoperativ e deaths. The 30-day perioperative mortality rate was 9 percent (7 of 74), with only 1 death related to persistent sepsis. The morbidity rat e was 39 percent, with the most common complication being seroma manag ed by needle aspiration (18 of 14, 24 percent). The aesthetic and func tional results have been uniformly excellent.