The Split Pectoralis Flap: Combining the Benefits of Advancement and Turnover Techniques in Sternal Wound Reconstruction
Katarzyna E. Kania, MD, MPH.
Baylor College of Medicine, Houston, TX, USA.
PURPOSE: The pectoralis major is a versatile flap used as an advancement or turnover for sternal wound treatment. The advancement flap provides suboptimal inferior sternal coverage and poorly fills mediastinal dead space. The turnover flap covers the inferior sternum and fills dead space, but it requires disinsertion of the muscle from the humerus, resulting in function loss and cosmetic deformity.
METHODS: We describe a new technique of splitting the pectoralis muscle along its fibers, using the superior portion as an advancement flap and the inferior portion as a turnover flap.
RESULTS: Ten patients underwent the described technique. Nine patients healed without complications or repeat operations. One patient had a recurrent aortic graft infection requiring reoperation. One patient had a post-operative seroma requiring incision and drainage.
CONCLUSION: The split pectoralis flap combines the benefits and minimizes the drawbacks of both flaps. This technique provides coverage of the entire sternum without the necessity of an omental or rectus abdominis flap. While minimizing turnover flap morbidity and preserving the muscle’s function and cosmetic appearance, it provides obliteration of dead space in the lower one-third of the sternum and volume for mediastinal defects. Future studies will quantify and objectively analyze the functional and cosmetic benefits of this flap.
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