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CURRENT ISSUETHE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery


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The Journal of Cardiovascular Surgery 2001 June;42(3):359-64

CARDIAC SECTION 

 TECHNICAL NOTES

Reconstruction of the median sternotomy wound dehiscence using the latissimus dorsi myocutaneous flap

Dejesus R. A., Paletta J. D., Dabb R. W.

From ­the Department of Surgery Division of Plastic Surgery York Hospital, York, PA, ­USA

Background. Currently ­the inter­nal tho­rac­ic ­artery (ITA) is ­the con­duit of pref­er­ence ­for cor­o­nary ­artery revas­cu­lar­iza­tion. Although ­this ­artery ­offers sev­er­al advan­tag­es ­over ­the saph­e­nous ­vein ­there is a high­er inci­dence of post­op­er­a­tive ster­nal ­wound infec­tion ­with ­its ­use. This inci­dence fur­ther increas­es ­with ­the ­use of bilat­er­al inter­nal tho­rac­ic arter­ies (­BITA). The ­use of mus­cle or omen­tal ­flaps to ­treat ­this com­pli­ca­tion ­has sig­nif­i­cant­ly ­reduced ­the mor­bid­ity ­and mor­tal­ity. Typically ­the pec­tor­al­is ­major (PM) or ­the rec­tus abdom­i­nis (RA) mus­cles ­are ­the pre­ferred meth­od of recon­struc­tion of ­the infect­ed ster­not­o­my ­wound.
Methods. In a ret­ro­spec­tive ­study ­over a ­four-­year peri­od ­from February 1994 to October 1998, ­nine ­patients under­went recon­struc­tion of an infect­ed ­median ster­not­o­my ­wound ­with a lat­is­si­mus dor­si myo­cu­ta­ne­ous ­flap (­LDMF).
Results. All of ­the ­patients in ­our ­study ­were suc­cess­ful­ly treat­ed ­with a sin­gle ­LDMF ­with ­the excep­tion of ­one ­who ­required a rec­tus abdom­i­nis ­flap to cov­er ­the lat­er­al ­aspect of ­the recal­ci­trant ­postster­not­o­my infect­ed ­wound. There ­was a sin­gle ­patient ­who ­had a ­wound dehis­cence at ­the ­donor ­site.
Conclusions. The ­LDMF is reli­able ­and ­serves as an ­adjunct ­for treat­ing ster­not­o­my infec­tions. The ­flap pro­vides suf­fi­cient ­amount of ped­i­cle ­length ­and mus­cle ­mass ­for cover­age. Although ­there is a ­need to ­turn ­the ­patient ­into a lat­er­al decub­it­us posi­tion ­once ­the debride­ment is per­formed ­the ­flap har­vest ­and ­its mobil­iza­tion is tech­ni­cal­ly straight­for­ward ­with a ­short oper­a­tive ­time, 135 min­utes on aver­age ­with a ­range of 97 to 171 min­utes. Furthermore, ­there ­exists an ana­tom­i­cal advan­tage in ­using ­the ­LDMF; har­vest of ­the ­LDMF ­does ­not dis­rupt col­lat­er­al ­blood sup­ply to ­the ster­num ­and par­a­ster­nal tis­sues.

language: English


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