Hindawi Publishing Corporation Case Reports in Surgery Volume 2013, Article ID 451594, 4 pages http://dx.doi.org/10.1155/2013/451594 Case Report An Alternative Technique for Surgical Management of Poststernotomy Osteomyelitis and Reconstruction of the Sternal Defect Petros Konofaos, 1,2 Eleftherios Spartalis, 3 Grigorios Karagkiouzis, 3 Christos Kampolis, 3 and Periklis Tomos 3 1 Department of Plastic, Reconstructive and Craniofacial Surgery, Health Science Center, University of Tennessee, Memphis, TN 38163, USA 2 Department of Plastic Surgery, Medical School, Athens University, 106 76 Athens, Greece 3 Second Department of Propaedeutic Surgery, Medical School, Athens University, 106 76 Athens, Greece Correspondence should be addressed to Eletherios Spartalis; eletherios.spartalis@gmail.com Received 10 January 2013; Accepted 7 February 2013 Academic Editors: F.-M. Haecker and D. Mantas Copyright © 2013 Petros Konofaos et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Sternal osteomyelitis with or without mediastinal infection is a severe and rare complication of median sternotomy. In this paper, an alternative technique for the reconstruction of sternal defects with the use of bilateral pectoralis major pedicled muscle laps is presented. Case presentation. A 70-year-old man with the diagnosis of poststernotomy osteomyelitis underwent reconstruction of his sternal defect with the use of bilateral pectoralis major muscle laps. he patient had an uneventful recovery, and the physical examination revealed a normal range of motion for both upper limbs and sternal stability. Conclusion. he proposed technique incorporates a simple mobilization of the two pectoralis major muscles to be used as laps to ill the sternal defect without the need for humeral detachment or a second cutaneous incision. Using this technique, a muscular implant is made that seals the dead space, which has no tension due to the presence of a second layer. Postoperative results are excellent, not only regarding infection and functionality but also from an aesthetic point of view. 1. Introduction Poststernotomy infection due to coronary artery bypass grating represents one of the greatest challenges for the reconstructive surgeon. Its incidence is ranged between 1% and 4% [1, 2]. Mainstay of the reconstruction of sternal defects is to provide long term and stable coverage of thoracic viscera without marked patient morbidity. Many authors have described the use of other muscles as laps [3, 4]. In this paper, we evaluate the postoperative results of the use of the bilateral pectoralis major pedicled muscle lap with the use of an alternative technique for reconstruction of sternal defects. 2. Case Presentation A 70-year-old man, diabetic, with ejection fraction of about 20%, was referred at the Second Department of Propaedeu- tic Surgery of Athens University with a chest pain and a sternocutaneous istulous tract discharging pus (Figure 1). Seven weeks earlier, he had undergone a redo coronary artery bypass via median sternotomy. he routine labora- tory tests were within normal limits, except an elevated white blood cell count (18 × 10 3 /L) and high  level (135 mg/L). Arterial blood gas analysis on admission day was PO 2 : 86 mmHg, PCO 2 : 39mmHg, pH: 7.4, SPO 2 : 96%, and HCO 3 - : 23.6 mmol/L. he diagnosis of poststernotomy sternal infection was set based on the patient’s medical history and clinical examination. he culture of the pus revealed methicillin resistant Staphylococcus aureus (MRSA). his infection was treated with administration of vancomycin for 6 weeks on the basis of microbiologic susceptibility. he patient underwent reconstruction of his sternal defect with the use of an alternative technique proposed by Tomos et al. [5]. he procedure was started with a V-shape partial sternectomy of the midline (Figure 2). he thoracic skin was undermined over both pectoralis major muscles from the