Combined free flaps with arteriovenous loops for reconstruction of extensive thoracic defects after sternal osteomyelitis

Taeger, Christian D.; Horch, Raymund E.; Arkudas, Andreas; Schmitz, Marweh; Stübinger, Axel; Lang, Werner; Meyer, Alexander; Seitz, Timo; Weyand, Michael; Beier, Justus P.

doi:10.1002/micr.22405

Cited by 37 publications

(51 citation statements)

References 24 publications

(46 reference statements)

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“…More recently, the free myocutaneous flap has been described for sternal wound closure and viewed as a new choice to repair the extensive thoracic defects after DSWI. [7,10] …”

Section: Discussionmentioning

confidence: 99%

“…[9] However, several authors reported that this flap may not be considered as a viable option for sternal defects reconstruction when the ipsilateral or bilateral internal mammary artery (IMA) had been harvested for coronary artery bypass grafting (CABG). [10,11] In this situation, can we make full use of the inferior epigastric vessels? When the RAMF is rotated by 180° into the thoracic defects, the inferior epigastric artery (IEA) can be anastomosed to the intercostal artery or the IMA perforator.…”

Section: Introductionmentioning

confidence: 99%

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Management of the extensive thoracic defects after deep sternal wound infection with the rectus abdominis myocutaneous flap

Zhao²,

Yang³

et al. 2017

Medicine

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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.

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“…More recently, the free myocutaneous flap has been described for sternal wound closure and viewed as a new choice to repair the extensive thoracic defects after DSWI. [7,10] …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Management of the extensive thoracic defects after deep sternal wound infection with the rectus abdominis myocutaneous flap

Zhao²,

Yang³

et al. 2017

Medicine

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“…This is particularly relevant when it comes to the presence of exposed neurovascular structures and when dead spaces result from tumour bulk removal beneath the closed incision in the irradiated field. Therefore, a thorough preoperative evaluation of the patient should be carried out by all of the surgical teams performing the oncological resection and the reconstruction as described in case 3 . After radical resection of the tumour, reconstruction of any vessels that may have been damaged should be performed before the surgical procedure is turned over to the reconstructive surgeon .…”

Section: Discussionmentioning

confidence: 99%

Management of extremely hard‐to‐heal extremity wounds with severe life‐threatening complications

Cai

Boos

Arkudas

et al. 2016

International Wound Journal

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The introduction of neoadjuvant radiotherapy has allowed limb-preserving surgical treatment in patients with extremity soft tissue sarcoma, and the overall prognosis of this approach is similar to that of limb amputation. The benefits of this treatment, however, are often accompanied with a higher risk of major complications and blood vessel damage because of radiation-induced inflammation and necrosis of the vessel wall. In particular, it is associated with the rupture of large vessels like the femoral artery and more severe complications of wounds located in the proximal lower extremity. We present a series of four patients with soft tissue sarcoma of the thigh undergoing tumour removal and reconstruction of the defect after neoadjuvant radiotherapy. The post-operative outcome depended on the total dose of radiation used as well as the closing technique of the resulting wound. Major wound complications occurred when the irradiated skin was closed directly over the resection cavity or when local skin flaps were used. In one case, severe radiation-induced life-threatening multiple bleeding events occurred, which led to multiple flap failures. Even if the skin cover is not a problem, we propose a combined interdisciplinary approach involving immediate plastic surgical transfer of healthy, well-vascularised tissue into a defect resulting from oncological resection of sarcoma of the lower extremity following neoadjuvant radiotherapy in order to avoid secondary wound breakdown and severe bleeding complications.

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“…Rekrutierung von gut perfundiertem Gewebe aus defektfernen, nicht affektierten Regionen und Schonen der Atemhilfsmuskulatur wird hierdurch erreicht. Ein weiterer Vorteil eines freien Muskellappens besteht darin, dass sich das transplantierte Gewebe lockerer in den tiefen Defekt einschlagen lässt und in der Tiefe fest verankert werden kann [20] [21,22]. Die Verwendung von freien Lappen muss bei diesem multimorbiden Patientengut dennoch streng indiziert sein, da jeglicher Weichteildefekt in dieser Region unserer Erfahrung nach mittels einer gestielten Lappenplastik suffizient verschlossen werden kann [15].…”

Section: Introductionunclassified

Der gefäßgestielte Omentumlappen zur Behandlung tiefer sternaler Wundinfekte

et al. 2017

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Combined free flaps with arteriovenous loops for reconstruction of extensive thoracic defects after sternal osteomyelitis

Abstract: Depletion of local recipient vessels as an obstacle for free flap reconstruction can be overcome by creating an arteriovenous loop. Even extensive defects are adequate for defect reconstruction using a single or, in extreme cases, bipedicled free flap.

Cited by 37 publications

References 24 publications

Management of the extensive thoracic defects after deep sternal wound infection with the rectus abdominis myocutaneous flap

Management of the extensive thoracic defects after deep sternal wound infection with the rectus abdominis myocutaneous flap

Management of extremely hard‐to‐heal extremity wounds with severe life‐threatening complications

Der gefäßgestielte Omentumlappen zur Behandlung tiefer sternaler Wundinfekte

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