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Management of the extensive thoracic defects after deep sternal wound infection with the rectus abdominis myocutaneous flap: A retrospective case series.

Abstract Deep sternal wound infection is a severe complication after open heart surgery. According to the different severity and dimensions of the deep sternal wound infection, the treatment method is different. In this study, we aimed to describe our experience with the rectus abdominis myocutaneous flap for large sternal wound management, especially when 1 or 2 internal mammary arteries were absent.Between October 2010 and January 2016, a retrospective review of 9 patients who suffered from the extensive thoracic defects after deep sternal wound infection was conducted. All of these sternal defects encompassed almost the full length of the sternum after debridement. Defect reconstruction was achieved by covering with a rectus abdominis myocutaneous flap. When the ipsilateral or bilateral internal mammary artery had been harvested previously, we took advantage of the inferior epigastric artery to provide additional blood supply to the rectus abdominis myocutaneous flap. Thus, this flap had a double blood supply.There was no recurrent infection in all 9 patients. Three patients received the rectus abdominis myocutaneous flap with a double blood supply. Flap complications occurred in 2 patients (22%). One patient who did not have the double blood supply flap suffered from necrosis on the distal part of the flap, which was then debrided and reconstructed with a split-skin graft. The other patient had a seroma at the abdomen donor site and was managed conservatively. None of the patients died during the hospital stay.This study suggests that the rectus abdominis myocutaneous flap may be a good choice to repair the entire length of sternal wound. When 1 or 2 internal mammary arteries have been harvested, the inferior epigastric artery can be anastomosed to the second intercostal artery or the internal mammary artery perforator to provide the rectus abdominis myocutaneous flap with a double blood supply.
PMID
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Authors

Mayor MeshTerms

Myocutaneous Flap

Keywords
Journal Title medicine
Publication Year Start




PMID- 28422830
OWN - NLM
STAT- MEDLINE
DA  - 20170419
DCOM- 20170501
LR  - 20170501
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 16
DP  - 2017 Apr
TI  - Management of the extensive thoracic defects after deep sternal wound infection
      with the rectus abdominis myocutaneous flap: A retrospective case series.
PG  - e6391
LID - 10.1097/MD.0000000000006391 [doi]
AB  - Deep sternal wound infection is a severe complication after open heart surgery.
      According to the different severity and dimensions of the deep sternal wound
      infection, the treatment method is different. In this study, we aimed to describe
      our experience with the rectus abdominis myocutaneous flap for large sternal
      wound management, especially when 1 or 2 internal mammary arteries were
      absent.Between October 2010 and January 2016, a retrospective review of 9
      patients who suffered from the extensive thoracic defects after deep sternal
      wound infection was conducted. All of these sternal defects encompassed almost
      the full length of the sternum after debridement. Defect reconstruction was
      achieved by covering with a rectus abdominis myocutaneous flap. When the
      ipsilateral or bilateral internal mammary artery had been harvested previously,
      we took advantage of the inferior epigastric artery to provide additional blood
      supply to the rectus abdominis myocutaneous flap. Thus, this flap had a double
      blood supply.There was no recurrent infection in all 9 patients. Three patients
      received the rectus abdominis myocutaneous flap with a double blood supply. Flap 
      complications occurred in 2 patients (22%). One patient who did not have the
      double blood supply flap suffered from necrosis on the distal part of the flap,
      which was then debrided and reconstructed with a split-skin graft. The other
      patient had a seroma at the abdomen donor site and was managed conservatively.
      None of the patients died during the hospital stay.This study suggests that the
      rectus abdominis myocutaneous flap may be a good choice to repair the entire
      length of sternal wound. When 1 or 2 internal mammary arteries have been
      harvested, the inferior epigastric artery can be anastomosed to the second
      intercostal artery or the internal mammary artery perforator to provide the
      rectus abdominis myocutaneous flap with a double blood supply.
FAU - Li, Yue-Hua
AU  - Li YH
AD  - aDepartment of Burns and Cutaneous Surgery, Xijing Hospital, The Fourth Military 
      Medical University bXi'an Jiaotong University Health Science Center, Xi'an,
      Shaanxi, China.
FAU - Zheng, Zhao
AU  - Zheng Z
FAU - Yang, Jiaomei
AU  - Yang J
FAU - Su, Lin-Lin
AU  - Su LL
FAU - Liu, Yang
AU  - Liu Y
FAU - Han, Fu
AU  - Han F
FAU - Liu, Jia-Qi
AU  - Liu JQ
FAU - Hu, Da-Hai
AU  - Hu DH
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Aged
MH  - Cardiac Surgical Procedures/adverse effects
MH  - Debridement
MH  - Epigastric Arteries/surgery
MH  - Female
MH  - Humans
MH  - Male
MH  - Mammary Arteries/surgery
MH  - Middle Aged
MH  - *Myocutaneous Flap/adverse effects/blood supply/pathology
MH  - Necrosis
MH  - Rectus Abdominis/blood supply/pathology/*surgery
MH  - Retrospective Studies
MH  - Sternum/*surgery
MH  - Surgical Wound Infection/pathology/*therapy
PMC - PMC5406046
EDAT- 2017/04/20 06:00
MHDA- 2017/05/02 06:00
CRDT- 2017/04/20 06:00
AID - 10.1097/MD.0000000000006391 [doi]
AID - 00005792-201704210-00011 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Apr;96(16):e6391. doi: 10.1097/MD.0000000000006391.

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