Poststernotomy wound management by debridement and pedicle flaps reconstruction.

BACKGROUND: Sternal wound infection and sternal dehiscence are very serious, sometimes life-threatening complications of cardiac surgery, which require immediate attention. The mortality rate can reach 50%. During the past 30 years,various flaps for coverage of sternal wounds have been described. OBJECTIVE: The authors objective was to evaluate their 7-year experience with flaps used for coverage of poststernotomy wounds, with an emphasis on flap selection and post repair complications. RESULTS: The records of 15 patients were reviewed. The most common coverage techniques were pectoralis major flap (n=5)and rectus abdominis flap (n=4). Four patients had both of these flaps. One patient had a latissimus dorsi flap, and another one had an omental flap. Eight of the 15 patients experienced a local complication; these included seroma(n=2), hematoma (n = 1), infection requiring debridement and antibiotics (n = 2), partial flap necrosis (n = 2) and abdominal hernia (n=1). The perioperative mortality rate was 13.3% (n = 2), and all deaths were attributable to multiple organ deficiency due to sepsis. CONCLUSIONS: Early debridement and coverage of the remained defects with flaps are the two main principles in the management of poststernotomy infected wounds, especially insituations where rapid wound healing and recovery are extremely important. Individual approach to each patient and proper selection of the method of reconstruction significantly reduces the postoperative morbidity and mortality rate.

Gastro-omental free flap in oro/hypopharyngeal reconstruction after enlarged ablative surgery for advanced stage cancer.

UNLABELLED: Reconstruction of complex mucocutaneous defects after ablative surgery for advanced cancer of the oropharynx, hypopharynx and larynx (Stages III and IV of disease according to TNM classification) with previous radiotherapy is a challenging problem for the plastic surgeon. The gastroomental free flap provides in these cases both a reliable mucosal lining of the digestive tract and soft tissue coverage in the neck. One-stage surgical excision and reconstruction improves the quality of life by reducing the hospitalization and providing recovery of the swallowing function. BACKGROUND: The method of reconstruction of the complex mucocutaneous defects that usually occur after extensive ablative surgery associated with radiotherapy for advanced malignant lesions of the oropharynx, hypopharynx and larynx should provide both digestive tract reconstruction and soft tissue coverage of the neck. The purpose of the article is to report our experience with the use of the gastroomental free flap for the reconstruction of such complex defects of the oro-and hypopharynx. METHOD: Gastro-omental free flap was used for one-stage reconstruction of complex defects of the oropharynx in four cases and hypopharynx in eleven cases between December 1990 and December 2008 after extensive ablative surgery for cancer. All fifteen patients had received previous irradiation. In all cases the tumor ablation was associated with neck dissection. RESULTS: There was one flap failure in this series (6.67%). Complications included: two cases of gastric outlet obstructions, one case of mild superficial bleeding of the transplanted gastric mucosa and three fistulas formed. Thirteen patients had adequate swallowing function after reconstruction of the digestive tract. CONCLUSION: Gastro-omental free flap represents a reliable and valuable solution in covering of extended and complex defects in the oral and cervical area following advanced cancer ablation.