Korean J Thorac Cardiovasc Surg.  2015 Aug;48(4):258-264. 10.5090/kjtcs.2015.48.4.258.

Therapeutic Outcomes of Pectoralis Major Muscle Turnover Flap in Mediastinitis

• Bagheri R
• Tashnizi M
• Haghi SZ
• Salehi M
• Rajabnejad A
• Safa MH
• Vejdani M

• KMID: 2382269
• DOI: http://doi.org/10.5090/kjtcs.2015.48.4.258

Abstract

BACKGROUND
This study aimed to evaluate the therapeutic results and safety of pectoralis major muscle turnover flaps in the treatment of mediastinitis after coronary artery bypass grafting (CABG) procedures.
METHODS
Data regarding 33 patients with post-CABG deep sternal wound infections (DSWIs) who underwent pectoralis major muscle turnover flap procedures in the Emam Reza and Ghaem Hospitals of Mashhad, Iran were reviewed in this study. For each patient, age, sex, hospital stay duration, remission, recurrence, and associated morbidity and mortality were evaluated.
RESULTS
Of the 2,447 CABG procedures that were carried out during the time period encompassed by our study, DSWIs occurred in 61 patients (2.5%). Of these 61 patients, 33 patients (nine females [27.3%] and 24 males [72.7%]) with an average age of 63+/-4.54 years underwent pectoralis major muscle turnover flap placement. Symptoms of infection mainly occurred within the first 10 days after surgery (mean, 10.24+/-13.62 days). The most common risk factor for DSWIs was obesity (n=16, 48.4%) followed by diabetes mellitus (n=13, 39.4%). Bilateral and unilateral pectoralis major muscle turnover flaps were performed in 20 patients (60.6%) and 13 patients (39.4%), respectively. Complete remission was achieved in 25 patients (75.7%), with no recurrence in the follow-up period. Four patients (12.1%) needed reoperation. The mean hospitalization time was 11.69+/-6.516 days. Four patients (12.1%) died during the course of the study: three due to the postoperative complication of respiratory failure and one due to pulmonary thromboembolism.
CONCLUSION
Pectoralis major muscle turnover flaps are an optimal technique in the treatment of post-CABG mediastinitis. In addition to leading to favorable therapeutic results, this flap is associated with minimal morbidity and mortality, as well as a short hospitalization time.

Keyword

Medistinitis; Coronary artery bypass; Deep sternal wound infection; Pectoralis muscle turnover flap; Morbidity

MeSH Terms

Coronary Artery Bypass
Diabetes Mellitus
Female
Follow-Up Studies
Hospitalization
Humans
Iran
Length of Stay
Male
Mediastinitis*
Mortality
Obesity
Postoperative Complications
Pulmonary Embolism
Recurrence
Reoperation
Respiratory Insufficiency
Risk Factors
Wound Infection