Limited bilateral advancement of the sternocostal head of pectoralis major for sternal reconstruction: preserving the axillary fold

Rozen, Warren M., Teo, Ken G.W., Sivarajah, Gausihi, and Acosta, Rafael (2017) Limited bilateral advancement of the sternocostal head of pectoralis major for sternal reconstruction: preserving the axillary fold. International Surgery, 102 (3-4). pp. 189-195.

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Abstract

The introduction of well-vascularized flaps for infected sternotomy wound reconstruction has improved mortality rates dramatically. Multiple variations of the pectoralis major flap have been described in this context. However, unresolved limitations of this flap include poor cosmesis and problematic coverage of the inferior third of the sternotomy wound. We describe an approach to address these issues. The humeral attachments are preserved and bilateral muscles are advanced in a limited fashion. The left sternocostal head is advanced medially and rotated anticlockwise, using this portion to fill the upper half of the sternum while the caudal portion of the right pectoralis muscle is used as a turnover flap at the lower half of the wound. In all 25 patients, the anterior axillary fold was preserved bilaterally and the infection completely resolved. Complications included 3 cases of hematoma, 2 cases of coagulopathy, and 1 late bone sequestrum (aseptic). Although the study had a limited sample size, we had a high rate of success and few complications. With the preservation of bilateral axillary folds, good cosmesis, and adequate wound coverage, we recommend this modification of the pectoralis major flap in even complicated cases of mediastinitis.

Item ID: 53546
Item Type: Article (Research - C1)
ISSN: 0020-8868
Keywords: Sternotomy wound infection, Medistinitis, Pectoralis major flap, Limited bilateral advancement, Turnover flap
Date Deposited: 09 May 2018 08:02
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110323 Surgery @ 100%
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