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Pectoralis Major Turnover Versus Advancement Technique for Sternal Wound Reconstruction

Zahiri, Hamid R. DO*; Lumpkins, Kimberly MD*; Kelishadi, Shahrooz MD*; Stromberg, Jeffrey A. MD; Silverman, Ronald P. MD; Slezak, Sheri MD; Goldberg, Nelson H. MD; Holton, Luther MD; Singh, Devinder P. MD

doi: 10.1097/SAP.0b013e3182367dc5
Reconstructive Surgery

Background We compared the efficacy of pectoralis turnover versus advancement technique for sternal wound reconstruction.

Methods A retrospective chart review was performed, December 1989 to December 2010, to compare postoperative complication rates between pectoralis major turnover versus pectoralis major advancement reconstruction techniques. Complications included hematomas, wound infections, tissue necrosis, dehiscence, and need for reoperation. Pearson χ2 and logistic regression were used and significance was P < 0.05.

Results Sixty-seven patients received 91 tissue flaps. Eleven patients (16%) required reoperation due to complications, including recurrent wound infection, tissue necrosis, wound dehiscence, mediastinitis, and hematoma formation. Four patients (6%) were treated conservatively for minor complications. Overall, complication rates were significantly higher after pectoralis major advancement reconstruction (32.5% vs. 3.7%, P = 0.004).

Conclusions When feasible, pectoralis major turnover flap offers a superior reconstructive technique for complex sternal wounds, with diminished complications compared with the pectoralis advancement flap.

From the *Division of General Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD; †Division of General Surgery, Department of Surgery, Cleveland Clinic School of Medicine, Cleveland, OH; and ‡Division of Plastic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.

Received July 11, 2011, and accepted for publication, after revision, September 6, 2011.

Conflicts of interest and sources of funding: none declared.

Reprints: Devinder P. Singh, MD, University of Maryland Medical, Department of General Surgery, 22 South Greene Street, Room S8D18, Baltimore, MD 21201. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.