Combined Use of Pediculated Muscle Flap and Z-Plasty in the Closure of Sternal Wounds in High-Risk Patients

Objective: Since deep sternal wound infections following sternotomy is a life-threatening complication, optimal management of sternal wounds still of vital importance. This study presents our 10-year experience with the use of pediculated muscle flaps and multiple Z-plasty techniques in reconstruction and tension-free closure of deep sternal wound and skin defects. Materials and Methods: 14 patients with deep sternal wound infection were referred to our clinic between 2006 and 2016 for the closure of the defect. Following aggressive debridement, all patients underwent closure of mediastinal defect using pediculated muscle flaps, whereas primary skin repair was performed in seven patients and another seven patients required multiple Z-plasties due to high skin tension. Results: The tension-free closure was performed in all patients. None of the patients developed muscle or skin flap necrosis. Of a total of three patients with postoperative complications, two of them developed seroma and one patient developed a hematoma. At a mean follow-up period of five years (six months to eight years), recovery was achieved with acceptable wound scar in patients who underwent repair with multiple Z-plasty techniques, whereas one patient who underwent primary repair experienced wound dehiscence in Week 1 after surgery and one patient developed hypertrophic scar in the long-term. Conclusion: Aggressive therapy with muscle flap reconstruction serves to reduce morbidity and mortality caused by sternal wound infection, whereas successful use of multiple Z-plasty techniques for skin closure allows the surgeon to perform tension-free closure and reduces the risk of skin necrosis, dehiscence and infections. Ama？: Sternotomiyi takiben derin sternal yara enfeksiyonu hayati tehlike olu？turan bir komplikasyon oldu？undan, sternal yaran？n optimum y？netimi halen büyük ？nem ta？？maktad？r. Bu ？al？？mada, derin sternal defekt ve cilt defektinde, rekonstrüksiyon ve gergin olmayan kapama elde etmek i？in pediküllü kas flepleri ve ？oklu z- plasti tekni？inin kullan？m？ ile ilgili 10 y？ll？k deneyimlerimiz sunulmaktad？r. Gere？ ve Y？ntem: 2006-2016 y？llar？ aras？nda derin sternal yara enfeksiyonu olan 14 hasta defekt kapat？lmas？ i？in klini？imize sevk edildi. Tüm hastalarda agresif debridman sonras？ mediastinal defekti kapama pediküllü kas flepleri ile, deri kapanmas？ ise birden fazla z-plasti kullan？larak yap？ld？. Bulgular: Bütün hastalarda gerilimsiz bir defekt kapat？lmas？ sa？land？. Hi？bir kas ve deri flep nekrozu olu？mad？. Toplam 3 hastan？n ikisinde seroma ve 1 hastada hemotom gibi postoperatif