Results of the modified bi-pectoral muscle flap procedure for post-sternotomy deep wound infection.

Journal Article (Journal Article)


Post-sternotomy deep sternal wound infection (DSWI) is a severe complication of cardiac surgery. The introduction of omental and muscle flaps has resulted in a significant decrease in morbidity and mortality. In this article, we present the findings for a series of 55 consecutive patients with DSWI treated using an alternative bi-pectoral musculofascial flap technique.


The patients were stratified into two groups (one-or two-stage intervention). Patients with septic wounds initially underwent debridement and wound treatment, while vacuum therapy was used in a subset of the subjects. All patients were treated with wound debridement and bi-pectoral advancement flap reconstruction.


30-day mortality was 5.4%. Most patients (72%) were treated in two stages, while vacuum therapy was used in 20% of the patients. The mean number of hospitalization days was 8 and 12 for the one- and the two-stage groups, respectively. Reconstruction was successful in all but three patients, each of whom developed recurrent infection. No major morbidity was reported at a mean follow-up of 82 months with excellent functional and aesthetic outcomes.


Pectoralis-major muscle flaps remain relevant in the modern management of post-sternotomy mediastinitis. The addition of an omental flap should be considered in cases in which the lower sternum is involved. Prompt diagnosis and a meticulous surgical technique ensure favorable results for the majority of patients.

Full Text

Duke Authors

Cited Authors

  • Spartalis, E; Markakis, C; Moris, D; Lachanas, E; Agathos, EA; Karakatsani, A; Karagkiouzis, G; Athanasiou, A; Dimitroulis, D; Tomos, P

Published Date

  • April 2016

Published In

Volume / Issue

  • 46 / 4

Start / End Page

  • 460 - 465

PubMed ID

  • 26026811

Electronic International Standard Serial Number (EISSN)

  • 1436-2813

International Standard Serial Number (ISSN)

  • 0941-1291

Digital Object Identifier (DOI)

  • 10.1007/s00595-015-1192-5


  • eng