Pedicled rectus abdominis musculocutaneous flap in reconstruction of lesions associated with sternus osteomyelitis and mediastinitis secondary to heart surgery

Objective To assess the therapeutic effect of the pedicled rectus abdominis musculocutaneous (PRAM)flap for reconstruction of sternal defects associated with sternus osteomyelitis and mediastintis after sternotomy.Methods Six patients with sternus osteomyelitis and mediastinitis,who received sternotomy in Jan.2002 to Jan.2006,underwent resection of sternum and partial costal cartilage;and the surface of the wound was then repaired by PRAM flap.Results All the flaps lived well after operation with no necrosis.No reoccurrence of osteomyelitis was noticed and the PRAM flap effectively reconstructed the defects after operation,sealed the trauma,and obtained satisfactory outcome in the reconstruction sites.The circulation and respiration functions of the patients were normal after operation,with no abnormal respiration or complication in the donor sites in the abdomen.One patient who underwent arteriovenous anastomosis had patent anastomosis as revealed by angiography.The anastomosis had good communication with the adjacent tissues.All the patients obtained satisfactory healing of the flaps without infection during the over 2 years follow up.Conclusion PRAM flap is effective and safe to treat sternal defects associated with osteomyelitis and mediastinitis following cardiac operation.