RECONSTRUCTION OF POST-STERNOTOMY ANTERIOR THORACIC WALL DEFECT USING A RECTUS ABDOMINIS MUSCLE FLAP.

Introduction: Reconstruction of anterior thoracic wall are considered a challenge regarding restoration of form and function. Sternum dehiscence represents a possible complication after cardiac surgery especially in non-compliant, multiple-operated patients. Muscular flaps provide an excellent option for stable soft tissue defects coverage as well as a well vascularised surface. Case Report: This paper presents the case of a 75-year-old male patient with a complex medical record of multiple cardiovascular and lung diseases who was transferred from IUBCvT to Plastic and Reconstructive Surgery Compartment of Târgu-Mureş for a post sternotomy wound dehiscence. Previous interventions that required this maneuver consisted in aortic valve replacement and coronary artery bypass followed by sternal osteosynthesis using stainless steel wires. The first intervention was minimal due to patient post-surgical complications (osteitis, mediastinitis, bilateral pachypleuritis) and consisted in soft tissue debridement, eschilectomy, thoracentesis for bilateral pneumothorax performed by thoracic surgeon and sutures inanatomical planes. Reintervention was required due to poor post-operative care after hospital discharge and recurrence of the initial dehiscence. Reconstruction of the thoracic wall was tempted using two local advancement cutaneous flaps with unfavourable results and flaps necrosis. Substantial debridement of the necrotising tissue with sternal osteotomy were necessary to create a favourable ground for reconstructive methods. For proper coverage of the exposed mediastinum a rectus abdominis muscle flap rotated on its proximal pedicle was placed over the sternum. After a midline incision was performed, the muscle was dissected from its fascial layer with the visualisation of superior epigastric artery and deep inferior artery, the latest being ligatured after suprapubic muscle sectioning. After rising the flap over the defect, coverage was ensured by a skin graft harvested from the anterior aspect of the left tight and the abdominal fascia was reinforced using a polypropylene surgical mesh. Postoperative the patient is admitted to the ICU for supportive treatment. Discussions : After a 5-day follow-up the muscular flap was viable, with minimal 4/2cm marginal skin graft necrosis for which negative pressure wound therapy (Vivano) was applied. Sutures were removed progressively at 2-3 weeks after the surgery without any further complications and spontaneous epithelization of skin graft necrosis site. Conclusions: A notable improvement in clinical results and patient improving health condition was made possible by the effective use of a multimodal therapy strategy. The significance of proper reconstructive techniques and preparation in the management of intricate postoperative complications is demonstrated by the notable final result of the presented case. [ABSTRACT FROM AUTHOR]