Wound complication after modified Ravitch for pectus excavatum: A case of conservative treatment enhanced by pectoralis muscle transposition

Ravitcha b s t r a c tINTRODUCTION: Multiple surgical debridement sessions are mandatory before wound closure in cases ofinfection after a modified Ravitch procedure for pectus excavatum. Vacuum-assisted closure (VAC) is awell-established technical resource for treating complicated wounds; however, in cases of suspicion ofbone infection, this approach is not enough to prevent bar removal.PRESENTATION OF THE CASE: We present a case of surgical wound dehiscence with hardware exposure in apatient who had undergone chondrosternoplasty for pectus excavatum. Several sessions of debridement(three) and VAC were applied every time. The final result was achieved without the necessity to removethe hardware; however, to avoid the risk of infection, a bilateral pectoralis muscle flap mobilization wasperformed as the final step after the surgical wound revisions, although this approach is suggested tobe used during the modified Ravitch procedure. This approach allows for a significant reduction in latecomplications and improves morphological outcomes.DISCUSSION: In summary, the pectoralis muscle flap transposition is very useful not only for aestheticalresults but also in combination with multiple surgical revisions for conservative management in caseof wound infection during a modified Ravitch procedure. In our case, this technique was adopted afteraccurate care of the wound and before the final closure, which helps to maintain good vascularizationand a very satisfying result.CONCLUSION: It is important to consider this approach during the modified Ravitch procedure, not onlyfor better aesthetical results but also to prevent infections or wound dehiscence at the level of the bar