Discussion: Predictors of Complications After Pectoralis Major Transposition for Sternum Dehiscence
We read with great interest the article entitled “Predictors of Complications After Pectoralis Major Transposition for Sternum Dehiscence” by Molenkamp et al.1
We found it as a very interesting attempt to identify predictors of postsurgical complications. In our clinical practice from January 2003 to date, we have solved 54 cases of poststernotomy mediastinitis. The technique used in our department includes 3 steps as those listed by the author: debridement, negative pressure therapy, and cover with pectoral muscles as advancement flap. As described by the authors, the pectoral muscle is removed from the humeral insertion.
As is known in the literature, the percentage of postsurgical complications is very high in these patients.2,3 In our series, as described by the authors of the article under discussion, the dehiscence of the surgical wound was the main cause of reoperation; this resulted in an increase of biological risks for the patient and hospitalization costs. Since 2012, we started to apply the negative pressure therapy on surgical wound after coverage with advancement flaps with pectoral muscles. In fact, in the literature, the use of the negative pressure on skin sutures to prevent a dehiscence of the wound is cited. In our experience, we apply the negative pressure therapy to −80 mm Hg for 7 days to prevent the surgical dehiscence. The rationale of this use is in improving the microcirculation to ensure a lower percentage of dehiscence. We also believe that the chests of obese women may reduce the mechanical stress exerted by the weight of the breasts, keeping more adherent cutaneous and muscle flaps.
We believe that the key to our communication can be a preventive management, when you suspect a suffering skin or sutures, through the use of negative pressure therapy. In fact, the early use allows drainage of secretions and prevents tissue maceration; this provides a better preservation of the same. The negative pressure therapy has been shown to reduce the infectious load (always present in the prosthesis exposures) and to increase the perfusion of the microcirculation (the basis of the wound healing processes).4,5
We believe that integrating the postoperative management with negative pressure therapy as a preventive measure can reduce cases of dehiscence of the surgical wound, biological cost to the patient, and hospitalization costs.