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Ann Thorac Surg 1995;60:1032
© 1995 The Society of Thoracic Surgeons

Invited Commentary

Invited Commentary

Maurice J. Jurkiewicz, MD

Emory University 1327 Clifton Rd NE Atlanta, GA 30322

See also page 1028.

This article by Banic and colleagues reports the use of a free musculocutaneous flap of the latissimus dorsi in 7 consecutive patients treated for median sternotomy wound infection. Free compound flaps revascularized by microsurgical techniques are now commonplace. To my knowledge and the collective knowledge of my colleagues at Emory, however, this is the first report of such use of a free flap in patients with median sternotomy wound infection.

One cannot gainsay the end result in the patients so treated by Banic and colleagues. One is obliged, however, to question the indications for its use rather than conventional techniques using pectoralis major muscle. Banic and colleagues not only resected skin but removed a considerable amount of it and performed debridement that included a total sternotomy, costochondral arches and sternoclavicular joints. Resection of skin is uncommon in our practice except in chronic cases with numerous and confluent sinus tracts. Adequate debridement is the hallmark of a successful outcome. Rarely have we had to resect to the degree of debridement employed by Banic and colleagues. The use of the internal mammary artery to revascularize the heart clearly renders the sternum relatively ischemic. Debridement has to be more extensive on the left half if infected. In most cases, even in large defects, a left pectoralis major turnover or advancement on its major pedicle will provide the requisite muscle to obliterate dead space. Rarely is it necessary to resort to omentum or to rectus abdomen.

Microsurgery, however ubiquitous, is still not for everyone, nor is it always the first and best option as implied in this article. Conventional regional muscle flaps have served our patients well when used for the treatment of median sternotomy wound infections.


Related Article

Free Latissimus Dorsi Flap for Chest Wall Repair After Complete Resection of Infected Sternum
Andrej Banic, Hans-Beat Ris, Dominique Erni, and Heinz Striffeler
Ann. Thorac. Surg. 1995 60: 1028-1032. [Abstract] [Full Text]




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