Abstract
Background Bilateral PM muscles or combination with rectus abdominis or omentum are commonly
used for upper and lower sternal wound infections. Unilateral PM harvesting using
endoscopic-assisted method may have a simple, safe, and reliable entire muscle harvesting
with comparable result of less donor-site violation.
Methods A retrospective review was performed from 2003 till 2015 on 38 patients referred
to a single plastic surgeon for treatment of sternal wound infection following median
sternotomy for cardiovascular surgery. After the humerus insertion of PM was cut with
the assistance of endoscope visualization, all the other PM insertions on the sternum,
rib, and clavicle were divided, the unilateral pedicled PM can be advanced approximately
10 cm to cover the cephalad and caudal sternum, and fill the retrosternal mediastinum.
Results Four re-explorations in three patients for postoperative hematoma occurred. No early
recurrent infection for wound dehiscence experienced. Three patients died of multiple
organs failures as 30-day mortality. Two patients underwent late recurrent infections;
one patient had twice wire infection removals at 4 and 6 months after transfer, and
the other had another PM for rib osteomyelitis in 3 years.
Conclusion Unilateral PM transfer is justified to provide a simple, reliable, straightforward
procedure for sternal infection management and mediastinal obliteration without violation
of second flap in compromised patients.
Keywords
pedicled pectoralis - endoscopic - sternal infection and mediastinitis
