Thoracic reconstruction with bilateral pectoral flap advancement secondary to paraesternal defect. A case report

Background: Infected sternal wounds are one of the serious complications in patients undergoing cardiothoracic surgery, with a significant impact on morbidity, length of hospital stay, and mortality. Their management and treatment represent a challenge for the surgical team, as immediate and adequate coverage of an unstable and devascularized wound is required to restore the integrity of the chest wall and prevent deep infections. In this context, the pectoralis major flap has proven to be a versatile, safe, and effective option, widely used in head, neck, and anterior thoracic reconstruction. We present the case of a 69-year-old female patient with a history of multivascular coronary artery disease who underwent coronary artery bypass grafting. On the fourth postoperative day, a granuloma developed in the sternal wound, leading to the indication of surgical resection and coverage with a pectoralis major flap using the advancement technique. During the procedure, a sternal defect measuring approximately 6 cm was identified. A supracostal release of the right pectoralis major muscle (5 cm) and a contralateral dissection (5 cm) were performed, allowing both muscles to be moved toward the midline without generating tension, achieving complete coverage of the defect. The postoperative course was favorable, with no acute complications, adequate flap integration, and progressive wound healing. This case highlights the usefulness of the pectoralis major flap as a reliable tool for the reconstructive management of complex sternal defects in the context of cardiothoracic surgery. Keywords: Sternotomy; Pectoralis major; Advancement flap, Wound infection.