Korean J Thorac Cardiovasc Surg.  2016 Oct;49(5):366-373. 10.5090/kjtcs.2016.49.5.366.

Pectoralis Muscle Flap Repair Reduces Paradoxical Motion of the Chest Wall in Complex Sternal Wound Dehiscence

• Zeitani J
• Russo M
• Pompeo E
• Sergiacomi GL
• Chiariello L

• KMID: 2354371
• DOI: http://doi.org/10.5090/kjtcs.2016.49.5.366

Abstract

BACKGROUND
The aim of the study was to test the hypothesis that in patients with chronic complex sternum dehiscence, the use of muscle flap repair minimizes the occurrence of paradoxical motion of the chest wall (CWPM) when compared to sternal rewiring, eventually leading to better respiratory function and clinical outcomes during follow-up.
METHODS
In a propensity score matching analysis, out of 94 patients who underwent sternal reconstruction, 20 patients were selected: 10 patients underwent sternal reconstruction with bilateral pectoralis muscle flaps (group 1) and 10 underwent sternal rewiring (group 2). Eligibility criteria included the presence of hemisternum diastases associated with multiple (≥3) bone fractures and radiologic evidence of synchronous chest wall motion (CWSM). We compared radiologically assessed (volumetric computed tomography) ventilatory mechanic indices such as single lung and global vital capacity (VC), diaphragm excursion, synchronous and paradoxical chest wall motion.
RESULTS
Follow-up was 100% complete (mean 85±24 months). CWPM was inversely correlated with single lung VC (Spearman R=−0.72, p=0.0003), global VC (R=−0.51, p=0.02) and diaphragm excursion (R=−0.80, p=0.0003), whereas it proved directly correlated with dyspnea grade (Spearman R=0.51, p=0.02) and pain (R=0.59, p=0.005). Mean CWPM and single lung VC were both better in group 1, whereas there was no difference in CWSM, diaphragm excursion and global VC.
CONCLUSION
Our study suggests that in patients with complex chronic sternal dehiscence, pectoralis muscle flap reconstruction guarantees lower CWPM and greater single-lung VC when compared with sternal rewiring and it is associated with better clinical outcomes with less pain and dyspnea.

Keyword

Sternum; Wound dehiscence; Cardiac surgical procedures, adverse event

MeSH Terms

Diaphragm
Dyspnea
Follow-Up Studies
Fractures, Bone
Humans
Lung
Pectoralis Muscles*
Propensity Score
Sternum
Thoracic Wall*
Thorax*
Vital Capacity
Wounds and Injuries*