The Split Pectoralis Flap: Combining the Benefits of Pectoralis Major Advancement and Turnover Techniques in One Flap
Two main points of the article remain doubtful. First, these patients are usually anticoagulated, and thus splitting the muscle fibers can increase the risk of bleeding and hematoma formation, which reaches 20 percent in some clinical series.3 Furthermore, usually the internal mammary vessels are not present because of their use in previous cardiac surgery.
In our practice, we carry out a staged reconstruction,4 consisting of surgical débridement and negative-pressure therapy until negativization of microbiological specimens is achieved. Negative-pressure therapy led to early removal of infective material3,5 and helped to reduce dead space.4 Then, a monolateral advancement pectoralis major flap, including a piece of rectus fascia, is harvested for wound closure. We congratulate the authors on the newly described technique because it led to coverage of the entire sternum and full obliteration of the inferior dead space with reduction of the area for seroma formation and long-term wound stability.