Revisiting vascularized muscle flaps for complicated sternal wounds in children.

Surgeons at our center previously reported a case of a 2-month-old infant who underwent closure of an infected sternal wound following open cardiac surgery with debridement followed by closure with bilateral pectoralis muscle flaps and a unilateral rectus abdominis muscle flap. The success of the procedure has spawned refinements in the technique, such as the one described herein. A 2-week-old neonate was evaluated for postoperative sternal dehiscence and instability following open cardiac surgery for severe congenital cardiac anomalies. Management included initial debridement and application of a vacuum-assisted closure (V.A.C.) system (KCI, Oxfordshire, UK). In conjunction with the final V.A.C. dressing change, the patient underwent delay of the left rectus muscle by division of the inferior epigastric pedicle. She subsequently underwent transposition of the left rectus muscle and application of a full-thickness skin graft for coverage of the sternal defect. She has since done well and still requires further invasive cardiac procedures.