Sternal wound closure by modified bipedicle pectoralis myocutaneous flaps

Background Closure of the deep sternal wound is a well-known challenge for chest and plastic surgeons. Various techniques have been described. However, there remains a need for a better one-a simple, safe procedure with minimal complications for patients, who usually present with underlying serious comorbidities. We present our technique for medium-size sternal wound closure in men. Methods Nineteen male patients, aged 52 to 85 years (average 71.7 years), with severe risk factors and underlining diseases underwent sternal wound closure with modified bipedicle pectoralis major myocutaneous flaps. The flaps have a rich blood supply from perforators of the pectoralis major muscles and branches of the thoracoacromial and superior epigastric arteries. This technique was performed as a single procedure for 12 patients (63%), as a second procedure for six patients (32%), and as a third one for one patient (5%). There was no need for humeral detachment of the muscle, and the skin deficit was solved by mobilizing skin medial to the axilla. Results No ischemic changes or dehiscence was shown in any of the flaps. Three patients (16%) had a second procedure, two because of bleeding in POD1 and POD14, and one due to infection. One patient (5%) had pulmonary emboli. Another patient (5%) had severe pulmonary effusion. Four patients (21%; average age 76y) died perioperatively (sepsis in 3 and cardiac arrest in 1). Conclusions The modified bipedicle pectoralis myocutaneous flaps technique is safe and simple. It should be considered in medium-size sternal wound closure in men. Level of evidence: Level IV, therapeutic study.