Surgical Management of the Symptomatic Unstable Sternum with Pectoralis Major Muscle Flaps

Background: Sternal nonunion after median sternotomy is an uncommon but potentially disabling complication. The management of nonunion varies based on the discretion of the cardiovascular surgeon. Methods: An analysis of all patients with symptomatic sternal nonunion who underwent wire removal, subtotal sternal debridement, and muscle flap reconstruction from 1993 to 2008 was conducted. A retrospective review was performed to evaluate preoperative and postoperative symptoms, pain scores, procedures, length of hospital stay, operating time, complications, morbidity, and mortality. Results: A total of 24 patients were identified. The male-to-female ratio was 11:1. Time from initial median sternotomy to consultation ranged from 5 to 48 months. All were referred when stability was not achieved by other means. None of the patients had clinical or laboratory evidence of sternal wound infection at presentation. The patients rated their preoperative pain severity at an average of 7.7 and a maximum of 10 on a scale of 1 to 10. All intraoperative cultures showed no growth. The operating time averaged 104 minutes. The average length of stay for these patients was 2.5 days. Follow-up ranged from 2 to 15 months, with an average of 4.2 months. All patients had clinically improved sternal stability. Conclusions: All patients experienced improvement of their preoperative symptoms, particularly pain, popping, and grinding. Average pain severity dropped from 7.7 preoperatively to 2.2, with a maximum of 4. Two patients developed seroma and required operative drainage. Both went on to complete healing. The mortality rate was 0 percent. (Plast. Reconstr. Surg. 123: 1495, 2009.)