Abstract: Pectoralis Turnover Versus Advancement Flap for Sternal Wound Reconstruction: A 21-Year Experience (Plastic Surgery 2011 (September 23-27, 2011))

Sunday, September 25, 2011: 10:20 AM

Colorado Convention Center

Hamid Reza Zahiri, DO , General Surgery, University of Maryland, Baltimore, MD

Kimberly Lumpkins, MD , General Surgery, University of Maryland, Baltimore, MD

Shahrooz Kelishadi, MD , General Surgery, University of Maryland, Baltimore

Jeffrey A. Stromberg, MD , General Surgery, Cleveland Clinic, Cleveland, OH

Ronald P. Silverman, MD , University of Maryland, Baltimore, MD

Sheri Slezak, MD , University of Maryland, Baltimore, MD

Nelson Goldberg, MD , Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD

Luther Holton, MD , Plastic Surgery, University of Maryland, Baltimore, MD

Devinder P. Singh, MD , Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD

Presentation PDF file

Background

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.

18731 Pectoralis Turnover Versus Advancement Flap for Sternal Wound Reconstruction: A 21-Year Experience