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THE JOURNAL OF CARDIOVASCULAR SURGERY

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

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

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


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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.

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