Two-stage management of sternal wound infection using bilateral pectoralis major advancement flap

Objective: To report our experience using two staged bilateral pectoralis major flap as the sole treatment modality for sternal wound infection. Methods: A retrospective study of 9417 open-heart surgery cases performed between 1998 and 2003 at The Prince Charles Hospital. Sixty-eight patients were referred to the plastic surgical team for consideration of bilateral pectoralis major flap as the sole treatment modality for sternal wound infection. Results: There was a trend for early referral for flap operation (median 10 days) (p = 0.49). The median postoperative ventilation time and ICU stay were 1 and 2 days, respectively. The median hospital stay after flap operation was 15.5 days. One-year overall survival was 91%. Ninety-five per cent heated stable sternum was achieved with 100% failure in patients with chronically unstable sternum. Early referral appears to be an important factor in preventing osteomyelitis formation (p = 0.05) with the longest recurrence at 10 months postoperatively. Conclusions: The key to the successful management of deep sternal wound infection is early referral for pectoralis major flap operation. Our approach is safe with good tong-term outcomes. We recommend this approach in all severe deep sternal wound infection but not in patients with chronic unstable sternum. (c) 2006 Elsevier B.V. All rights reserved.