Prophylactic sternal plating with pectoralis advancement flaps after sternotomy in patients with a history of chest irradiation
Document Type
Article
Abstract
Deep sternal infections secondary to bony instability and malunion, can result in mediastinitis. Previous authors have described the use of prophylactic rigid plate fixation in high-risk patients. The purpose of our study is to review the use of prophylactic sternal platting with pectoralis advancement flaps in high-risk patients with a history of chest irradiation. Fourteen patients (July 2003-September 2008) with a history of chest irradiation who underwent a median sternotomy followed by prophylactic rigid plate fixation of the sternum were reviewed. Breast cancer was the most common etiology of chest irradiation (n=11, 78%). The average EuroSCORE was 24.06% with 72% of patients having a preoperative New York Heart Association (NYHA) class≥III. There were no episodes of sternal non-union, mediastinitis or death. Follow-up was 100% with a 0% 30-day and a 7.1% one-year mortality rate (non-cardiac). A comparison between mean preoperative left ventricular ejection fraction (LVEF) (49.6%) and postoperative LVEF (59.7%) was statistically significant (P<0.0001). All living patients currently maintain a NYHA class I/II. Prophylactic rigid plate fixation and pectoralis flap coverage decreases the risk of developing sternal dehiscence and postoperative wound complications and should therefore be considered in high-risk patients with a history of chest irradiation.
Medical Subject Headings
Aged; Bone Plates; Cardiac Surgical Procedures; Female; Humans; Male; Mediastinitis (etiology, prevention & control); Michigan; Pectoralis Muscles (surgery); Radiotherapy (adverse effects); Sternotomy (adverse effects, instrumentation, mortality); Surgical Flaps (adverse effects); Surgical Wound Dehiscence (etiology, prevention & control); Surgical Wound Infection (etiology, prevention & control); Thoracic Cavity (radiation effects); Time Factors; Treatment Outcome; Wound Closure Techniques (adverse effects, instrumentation, mortality)
Publication Date
3-1-2011
Publication Title
Interactive cardiovascular and thoracic surgery
E-ISSN
1569-9285
Volume
12
Issue
3
First Page
355
Last Page
8
PubMed ID
21138917
Digital Object Identifier (DOI)
10.1510/icvts.2010.247262
Recommended Citation
Neaman, Keith C.; Blount, Andrew L.; Kim, John A.; Renucci, John D.; and Hooker, Robert L., "Prophylactic sternal plating with pectoralis advancement flaps after sternotomy in patients with a history of chest irradiation" (2011). SJHMC Faculty. 48.
https://scholar.barrowneuro.org/sjhmc/48