CHEST WALL RECONSTRUCTION FOR STERNUM COMPLICATIONS IN CARDIOVASCULAR SURGERY: A SYSTEMATIC REVIEW

José Dalvo Maia Neto; Fabiano Jucá; Thomas Dominik de Souza dos Reis; Elmiro Heli Martins; Francisco de Assis Montenegro Carvalho; João Carlos Fechine Machado; João Pedro Barreto Ricarte; Heraldo Guedis Lobo Filho

Authors

José Dalvo Maia Neto
Fabiano Jucá
Thomas Dominik de Souza dos Reis
Elmiro Heli Martins
Francisco de Assis Montenegro Carvalho
João Carlos Fechine Machado
João Pedro Barreto Ricarte
Heraldo Guedis Lobo Filho

Keywords:

Mediastinitis, Sternal Osteomyelitis, Sternal Dehiscence, Surgical Flaps, Pectoralis Major Muscle, Rectus Abdominis Muscle, Cardiac Surgery, Median Sternotomy

Abstract

Introduction: Sternal suture dehiscence represents a serious complication after cardiac surgery, with an incidence ranging from 0.5% to 5% of median sternotomy procedures. This condition is associated with high morbidity and mortality rates, often requiring reconstructive surgical intervention. Muscle flaps, particularly the pectoralis major and rectus abdominis, constitute fundamental therapeutic options for the definitive treatment of this complication.

Objective: To conduct a systematic review of the literature on the use of muscle flaps in the reconstruction of mediastinal suture dehiscence after cardiac surgery, with emphasis on pectoralis major and rectus abdominis flaps, analyzing indications, surgical techniques, outcomes, and complications.

Methodology: Systematic literature review in PubMed, MEDLINE, Scopus, Web of Science, and LILACS databases, including articles published between 2010 and 2024. Studies addressing sternal dehiscence reconstruction with muscle flaps were selected, focusing on pectoralis major and rectus abdominis. The analysis included data on epidemiology, risk factors, surgical techniques, success rates, and complications.

Results: The literature demonstrates that pectoralis major flaps present success rates between 85-95%, being the first choice for anterior and lateral mediastinal defects. The rectus abdominis flap, with success rates of 80-92%, is indicated for extensive defects of the lower third of the sternum. Significant risk factors include diabetes mellitus, obesity, bilateral use of internal mammary artery, COPD, and deep infection. Mortality associated with mediastinitis ranges from 10% to 47% in recent literature.

Conclusion: Pectoralis major and rectus abdominis flaps represent effective and safe reconstructive options for treating sternal suture dehiscence. Flap selection should consider the location and extent of the defect, patient clinical conditions, and surgical team experience. Multidisciplinary approach and early treatment are fundamental for reducing morbidity and mortality. A systematized safety algorithm is proposed to optimize the management of this complication.

DOI: https://doi.org/10.56238/sevened2025.036-126