Reconstruction following dehiscence of median sternotomy

Dehiscence of a median sternotomy wound results in significant morbidity and mortality. These wounds are classified into 3 types according to the time of presentation from the original cardiac procedure and the appearance of the wound. The classification gives an indication of the degree of debridement necessary and whether flap reconstruction is required. We describe a series of 54 flaps in 41 patients. These included 27 pectoralis major myocutaneous advancement flaps, 12 pectoralis muscle turnover flaps, 6 rectus abdominus muscle flaps and 9 omental flaps. There was partial loss of one flap. The mortality rate of 8.6% compares favourably with the alternative procedures of open debridement and packing, or closed irrigation.