Background:
Deep sternal wound infection (DSWI) post coronary artery bypass grafting (CABG) is a
challenging complication with an incidence of 0.2 to 8% and a mortality rate of 7.3 to 21.6% (1).
Whilst pedicled flaps are the workhorse option for sternal reconstruction, free flaps are
increasingly used for salvage cases of DSWI. In the setting where the left internal mammary
artery (LIMA) has been used for cardiac revascularisation, most surgeons are hesitant
to use the right internal mammary artery (RIMA) as recipient vessels for free flaps for
fear of sternal devascularisation. This often necessitates dissection into the base of the
neck for suitable vessels and the use of vein grafts to increase pedicle length.
Case series:
We describe a case series using the free anterolateral thigh flap (ALT) for
reconstruction of sternal wounds in patients who have failed multiple pedicled flaps. The ALT
flap was successfully anastomosed to the RIMA in these salvage cases with good long-term patient outcomes.
Conclusion:
The ALT is a good salvage option for reconstruction of sternal wounds following DSWI. The
RIMA system appears to be safe to use as a recipient vessel for microvascular
anastomoses in patients post LIMA harvest.