Latissimus Dorsi Flap in the Treatment of Thoracic Wall Defects After Medial Sternotomy

Adam Stepniewski, MD; Joelle Krahlisch, MD; Alexander Emmert, MD; Ahmad-Fawad Jebran, MD; Maximilian Schilderoth, MD; Helen Synn, MD; Gunther Felmerer, MD


ePlasty. 2020;20(e4) 

In This Article


A retrospective cohort study was conducted; the resulting data were extracted from the electronic, photographic, and paper-based documentation, including records stored between January 2010 and September 2017. Only patients treated with pedicled-based latissimus dorsi flaps due to postoperative sternal wounds after median sternotomy were included. Preoperative, intraoperative, and postoperative data were collected with standardized protocols and were analyzed accordingly. We considered the following parameters as risk factors: obesity, tobacco smoking, and the presence of renal insufficiency, diabetes, arterial hypertonia, hyperlipoproteinemia, cardiac comorbidities, metabolic syndrome, sternal osteitis, interval between sternotomy and latissimus flap surgery, duration of flap surgery, an application of intraoperative high-dose norepinephrine, and occurrence of postoperative minor or major complications. We calculated, whether the risk factors and complications classified after Clavien and Dindo[4,5] have correlations to the survival rates. Furthermore, prognostic factors were identified. To assess the subjective outcome, we designed questionnaires for the patients, and the patients completed the survey in our outpatient clinic.

All reconstructive surgical procedures were performed by 2 surgeons from 2010 to 2017. All the data collected were statistically evaluated with univariate statistical tests (χ 2 test, t test, and Kaplan-Maier analysis with the Mantel-Cox log-rank test) and multivariate logistic regression analysis (Cox regression). Statistical analyses were conducted using the IBM SPSS Statistics version software. The data were anonymized according to the WMA Declaration of Helsinki, with the approval of the ethical commission (number 08/10/17). Informed consent from patients was obtained.