Use of free-tissue transfer in the treatment of median sternotomy wound infections: Retrospective review

The incidence of sternal wound infection following median sternotomy is 0.4 to 5 percent. Debridement and closure of the wounds with local and regional muscles, such as a pectoralis or a pedicled rectus abdominis, have been the mainstay of surgical treatment. Often, both pectoralis major muscles and the superior portion of a rectus abdominis muscle must be used to close large sternal wounds. Loss of these major muscles can be both debilitating and cosmetically disfiguring. Free-tissue transfer can be employed to limit the amount of tissue needed to fill the sternal defect. The authors present a series of 12 free-tissue transfers used in 11 patients to close large sternal defects in this subset of patients. Total flap loss occurred in one patient. Partial loss of the skin island was noted in three patients. Two patients developed abdominal hernias after rectus abdominis free flaps. Free-tissue transfer offers the ability to close these large wounds, using one muscle, in those patients where pedicled rectus abdominis flaps are not available.