D127. Flap Reconstruction Following Orthotopic Heart Transplant: A Single Institution’s Review of 66 Sternal Wound Complications

BACKGROUND: Sternotomy wound complications are more frequent in heart transplantation than other types of cardiac surgery due to the presence of additional risk factors, including immunosuppression. Definitive treatment often necessitates flap closure. METHODS: We retrospectively reviewed 604 sternal wound reconstructions performed by a single surgeon from 1995 to 2023. Patients who underwent heart transplantation as the index cardiac surgery were included. Surgical interventions involved sternal hardware removal, debridement, and muscle flap closure. RESULTS: Sixty-six patients were included. Sternal wounds were reconstructed with bilateral pectoralis major advancement flaps (n=63), rectus abdominis flaps (n=2), or pectoralis major turnover flaps (n=1). Intraoperative wound cultures were positive in 48 patients (72.7%), and staphylococcus epidermidis was the most frequently cultured organism (25.0%). The overall postoperative complication rate was 31.8%. Patients were followed in the outpatient clinic, and the majority reported excellent functional and aesthetic outcomes. CONCLUSION: Sternal wounds remain a highly morbid condition. The 30-day mortality rate was higher in the present cohort than in our study of heart transplant recipients published in 1995, possibly due to expanded eligibility criteria for transplantation and increased medical complexity of transplant recipients.