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Pectoralis major-rectus abdominis bipedicled muscle flap in the treatment of poststernotomy mediastinitis

Authors
 Tai Suk Roh  ;  Won Jai Lee  ;  Dae Hyun Lew  ;  Kwan Chul Tark 
Citation
 Journal of Thoracic and Cardiovascular Surgery, Vol.136(3) : 618-622, 2008 
Journal Title
 Journal of Thoracic and Cardiovascular Surgery 
ISSN
 0022-5223 
Issue Date
2008
MeSH
Adult ; Aged ; Coronary Artery Bypass ; Female ; Heart Valve Diseases/surgery ; Humans ; Male ; Mediastinitis/surgery* ; Middle Aged ; Pectoralis Muscles ; Postoperative Complications ; Rectus Abdominis ; Sternum/surgery* ; Surgical Flaps* ; Thoracic Surgical Procedures/methods ; Treatment Outcome
Keywords
Adult ; Aged ; Coronary Artery Bypass ; Female ; Heart Valve Diseases/surgery ; Humans ; Male ; Mediastinitis/surgery* ; Middle Aged ; Pectoralis Muscles ; Postoperative Complications ; Rectus Abdominis ; Sternum/surgery* ; Surgical Flaps* ; Thoracic Surgical Procedures/methods ; Treatment Outcome
Abstract
OBJECTIVES: Although the incidence of infected sternotomy wounds after median sternotomy for cardiovascular surgery is relatively low (0.5% to 5%), it is associated with significant morbidity and a long period of treatment. Today, muscle flaps, such as the pectoralis major or the rectus abdominis, are widely accepted as a mainstay of reconstructive options. Each method carries unavoidable limitations and setbacks of its own. To overcome the disadvantages of the pectoralis muscle and rectus abdominis muscle flaps, we designed and performed a pectoralis major-rectus abdominis muscle bipedicled flap for the coverage of sternal defects. METHODS: The pectoralis major-rectus abdominis bipedicled flap was elevated as a single unit, preserving the thoracoepigastric fascia in continuity with the rectus muscle and its anterior fascia. The method was used in 27 patients with postoperative mediastinitis during a 5-year period. RESULTS: The bipedicled flap could fill the defect with sufficient volume, not only in the upper two thirds but also in the lower one third of the sternum. Recurrent uncontrolled infection developed in 11% of all cases, and upper abdominal fascial attenuation was observed in 1 patient. There were no surgical intervention-related complications or deaths. CONCLUSIONS: We conclude that pectoralis major-rectus abdominis bipedicled flap is a practical and efficacious method in the reconstruction of the anterior chest wall defect caused by poststernotomy mediastinitis. It not only provides sufficient volume to fill the entire mediastinum but also affords resolution of the infected wound with favorable outcomes comparable with those of other methods.
Full Text
http://www.sciencedirect.com/science/article/pii/S0022522308008283
DOI
18805262
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Plastic and Reconstructive Surgery (성형외과학교실) > 1. Journal Papers
Yonsei Authors
Roh, Tai Suk(노태석) ORCID logo https://orcid.org/0000-0001-8681-159X
Lew, Dae Hyun(유대현)
Lee, Won Jai(이원재) ORCID logo https://orcid.org/0000-0003-3056-0503
Tark, Kwan Chul(탁관철)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/107495
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