Wound infection is a risk in all surgery. When this occurs after heart surgery, the wound in the breast bone may come apart or may require re-opening to cure the infection. In cases where the defect is wide or the heart surgeon is forced to remove significant amounts of damaged bone, tissue transfer by the plastic surgeon may be the patient's best hope. In these cases, muscles are transferred from the abdomen and/or chest to fill the defect prior to skin re-closure.
This female patient had an opening through the sternum which would require surgical trimming of infected tissues. The defect can not be closed over with skin alone, since the cavity beneath will likely continue to harbor infection.
This shows muscle moved from the right side of the abdomen and the chest to the wound.
The muscles are placed within the cavity to obliterate it.
This is the closed, healing wound.
Chest Resection for Cancer
When tumors invade the muscle and bone of the chest wall, removal of the full thickness of the chest wall is necessary. In order to protect the underlying vital organs and restore near-normal chest wall function, a complex reconstruction will be needed. This will often involve the placement of plastic material to reestablish chest wall rigidity, followed by coverage with a flap of muscle and skin, ( a so-called "myocutaneous flap.")
This shows the right chest after full thickness removal for tumor. Note the exposed lung.
This shows the placement of plastic mesh which is sewn to the tough soft tissue covering the rib edges.
This is the healing reconstruction after placement of a flap of muscle and skin.