The efficacy of sternal wound reconstruction with tissue flaps is well supported in the literature. We sought to compare the pectoralis turnover and advancement reconstructive techniques.
Methods
We performed a retrospective study of patients who underwent flap closure for complicated sternal wounds from December 1989 to December of 2010. Correlation between operative technique utilized and post-operative morbidity was analyzed. Post-operative complications included hematomas, seromas, wound infections, skin or wound or flap necrosis, wound dehiscence, and need for reoperations. Pearson chi-square and two-sample t test were used for statistical analysis. Significance was determined by p < 0.05.
Results
One-hundred six patients (67 males, 39 females), with average age of 61.8 years, received 161 total flaps for sternal wound repair including 62 pectoralis advancement, 29 pectoralis turnover, 3 omental, 1 latissimus dorsi, 1 rectus abdominus, and 62 mixed (turnover and advancement) flaps. Overall, 23 patients (including 13 with pectoralis advancement vs. 1 with pectoralis turnover) developed post-operative complications including recurrent wound infection, tissue necrosis, wound dehiscence, mediastinitis, and hematoma formation. Eighteen patients (17%) required a re-operation after their initial sternal reconstruction due to complications and the remaining 5 patients (5%) were treated conservatively. Importantly, our analysis found patients with advancement flaps were significantly more likely to develop a morbidity than those with turnover flaps (32.5% vs. 3.7%, p = 0.004), even after controlling for patient comorbidities (hypertension, diabetes, and congestive heart failure).
Conclusions
When feasible, use of the pectoralis turnover flap offers a superior reconstructive technique for complicated sternal reconstructions, with diminished morbidity compared to the pectoralis advancement flap.