Pectoralis Muscle Flap Repair Reduces Paradoxical Motion of the Chest Wall in Complex Sternal Wound Dehiscence
Background: The aim of the study was to test the hypothesis that in patients with chronic complex sternum dehiscence, the use of muscle flap repair minimizes the occurrence of paradoxical motion of the chest wall (CWPM) when compared to sternal rewiring, eventually leading to better respiratory fu...
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Korean Society for Thoracic and Cardiovascular Surgery
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doaj-2c1e79504ebb495d8090236cd23d3a672020-11-24T20:59:19ZengKorean Society for Thoracic and Cardiovascular SurgeryKorean Journal of Thoracic and Cardiovascular Surgery2233-601X2093-65162016-10-0149536637310.5090/kjtcs.2016.49.5.366Pectoralis Muscle Flap Repair Reduces Paradoxical Motion of the Chest Wall in Complex Sternal Wound DehiscenceJacob Zeitani0Marco Russo1Eugenio Pompeo2Gian Luigi Sergiacomi3Luigi Chiariello4Vergata UniversityVergata UniversityVergata UniversityVergata UniversityVergata UniversityBackground: The aim of the study was to test the hypothesis that in patients with chronic complex sternum dehiscence, the use of muscle flap repair minimizes the occurrence of paradoxical motion of the chest wall (CWPM) when compared to sternal rewiring, eventually leading to better respiratory function and clinical outcomes during follow-up. Methods: In a propensity score matching analysis, out of 94 patients who underwent sternal reconstruction, 20 patients were selected: 10 patients underwent sternal reconstruction with bilateral pectoralis muscle flaps (group 1) and 10 underwent sternal rewiring (group 2). Eligibility criteria included the presence of hemisternum diastases associated with multiple (≥3) bone fractures and radiologic evidence of synchronous chest wall motion (CWSM). We compared radiologically assessed (volumetric computed tomography) ventilatory mechanic indices such as single lung and global vital capacity (VC), diaphragm excursion, synchronous and paradoxical chest wall motion. Results: Follow-up was 100% complete (mean 85±24 months). CWPM was inversely correlated with single lung VC (Spearman R=−0.72, p=0.0003), global VC (R=−0.51, p=0.02) and diaphragm excursion (R=−0.80, p=0.0003), whereas it proved directly correlated with dyspnea grade (Spearman R=0.51, p=0.02) and pain (R=0.59, p=0.005). Mean CWPM and single lung VC were both better in group 1, whereas there was no difference in CWSM, diaphragm excursion and global VC. Conclusion: Our study suggests that in patients with complex chronic sternal dehiscence, pectoralis muscle flap reconstruction guarantees lower CWPM and greater single-lung VC when compared with sternal rewiring and it is associated with better clinical outcomes with less pain and dyspnea.http://www.kjtcvs.org/journal/download_pdf.php?doi=10.5090/kjtcs.2016.49.5.366SternumWound dehiscenceCardiac surgical proceduresadverse event |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jacob Zeitani Marco Russo Eugenio Pompeo Gian Luigi Sergiacomi Luigi Chiariello |
spellingShingle |
Jacob Zeitani Marco Russo Eugenio Pompeo Gian Luigi Sergiacomi Luigi Chiariello Pectoralis Muscle Flap Repair Reduces Paradoxical Motion of the Chest Wall in Complex Sternal Wound Dehiscence Korean Journal of Thoracic and Cardiovascular Surgery Sternum Wound dehiscence Cardiac surgical procedures adverse event |
author_facet |
Jacob Zeitani Marco Russo Eugenio Pompeo Gian Luigi Sergiacomi Luigi Chiariello |
author_sort |
Jacob Zeitani |
title |
Pectoralis Muscle Flap Repair Reduces Paradoxical Motion of the Chest Wall in Complex Sternal Wound Dehiscence |
title_short |
Pectoralis Muscle Flap Repair Reduces Paradoxical Motion of the Chest Wall in Complex Sternal Wound Dehiscence |
title_full |
Pectoralis Muscle Flap Repair Reduces Paradoxical Motion of the Chest Wall in Complex Sternal Wound Dehiscence |
title_fullStr |
Pectoralis Muscle Flap Repair Reduces Paradoxical Motion of the Chest Wall in Complex Sternal Wound Dehiscence |
title_full_unstemmed |
Pectoralis Muscle Flap Repair Reduces Paradoxical Motion of the Chest Wall in Complex Sternal Wound Dehiscence |
title_sort |
pectoralis muscle flap repair reduces paradoxical motion of the chest wall in complex sternal wound dehiscence |
publisher |
Korean Society for Thoracic and Cardiovascular Surgery |
series |
Korean Journal of Thoracic and Cardiovascular Surgery |
issn |
2233-601X 2093-6516 |
publishDate |
2016-10-01 |
description |
Background: The aim of the study was to test the hypothesis that in patients with chronic complex sternum
dehiscence, the use of muscle flap repair minimizes the occurrence of paradoxical motion of the chest wall
(CWPM) when compared to sternal rewiring, eventually leading to better respiratory function and clinical
outcomes during follow-up. Methods: In a propensity score matching analysis, out of 94 patients who underwent
sternal reconstruction, 20 patients were selected: 10 patients underwent sternal reconstruction with bilateral
pectoralis muscle flaps (group 1) and 10 underwent sternal rewiring (group 2). Eligibility criteria included
the presence of hemisternum diastases associated with multiple (≥3) bone fractures and radiologic
evidence of synchronous chest wall motion (CWSM). We compared radiologically assessed (volumetric computed
tomography) ventilatory mechanic indices such as single lung and global vital capacity (VC), diaphragm
excursion, synchronous and paradoxical chest wall motion. Results: Follow-up was 100% complete (mean
85±24 months). CWPM was inversely correlated with single lung VC (Spearman R=−0.72, p=0.0003), global
VC (R=−0.51, p=0.02) and diaphragm excursion (R=−0.80, p=0.0003), whereas it proved directly correlated
with dyspnea grade (Spearman R=0.51, p=0.02) and pain (R=0.59, p=0.005). Mean CWPM and single lung VC
were both better in group 1, whereas there was no difference in CWSM, diaphragm excursion and global VC.
Conclusion: Our study suggests that in patients with complex chronic sternal dehiscence, pectoralis muscle
flap reconstruction guarantees lower CWPM and greater single-lung VC when compared with sternal rewiring
and it is associated with better clinical outcomes with less pain and dyspnea. |
topic |
Sternum Wound dehiscence Cardiac surgical procedures adverse event |
url |
http://www.kjtcvs.org/journal/download_pdf.php?doi=10.5090/kjtcs.2016.49.5.366 |
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