[Use of a flap composed of skin and breast tissue for repairing a recalcitrant wound resulting from dehiscence of sternotomy in cardiac surgery].

Median sternotomy was first described in 1957 as an access route for cardiac surgery. Dehiscence of that incision has been associated with high indices of morbidity and mortality. In 1976, Lee et al 1 reported the use of the great omentum for covering that mediastinal flaw. A little later, Jurkiewicz et al 2 reported the use of muscular flaps, which favored the earlier repair of raw areas and a significant reduction in the indices of chronic infection because it added vascularized tissue. Debridement associated with early and aggressive use of antibiotics and, when necessary, the use of flaps has been the basis of the therapy in cases of dehiscence of sternotomy for the past 20 years, reducing drastically the indices of morbidity and mortality 3-6. Most dehiscences may be corrected only with resuture of the borders after an improvement in the conditions of the tissues involved. However, sometimes that is not possible due to tissue loss or when great tension is exerted in the final suture. The type of flap should be chosen according to the change present. The discussion about choosing a muscular or musculocutaneous flap or a cutaneous flap is based on the vascularization of each flap. A very well irrigated flap could favor the eradication of infection and increase the vitality of the tissues involved, favoring a more rapid stabilization of the infection and healing process. However, in 1981, some studies 7,8 about the use of different types of flaps for the treatment of pressure ulcers reported that cutaneous flaps or those composed of other tissues may have the same efficacy of muscular flaps, and eventually, provide a better and more effective esthetic result. Therefore, muscular flaps can be an option in cases of relapse. This study presents a new technique for reconstructing the sternal region with flaps composed of breast tissue in women. The result was effective, with lower morbidity and better quality than those of muscular flaps.