Conjoint muscle free flap for obliteration of an upper thoracic empyema cavity

Hallock, Geoffrey G.

doi:10.4172/plastic-surgery.1000375

Cited by 2 publications

(4 citation statements)

References 9 publications

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“…19 The thoracodorsal pedicle can also be extended without taking down the secondary blood supply to the latissimus, thereby completely preventing any ischemia to the flap. 20 To our knowledge, this is the first published case series on the outcomes of AV loop with latissimus free flap reconstruction of cervical and cervicothoracic wounds.…”

Section: Discussionmentioning

confidence: 88%

Arteriovenous Vascular Loops in Latissimus Free Flap Reconstruction of Cervical and Cervicothoracic Spine Wounds

Cinats

Harley

Loftus

2023

Journal of Hand and Microsurgery

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Introduction Wound dehiscence is the most common complication after spinal fusion procedures, resulting in an increase in mortality rate and hospital length of stay. Reconstruction of these wounds presents a challenge, as the spine is dependent on these implants for stability and must be maintained throughout the wound dehiscence treatment protocol. We describe a method for extending the thoracodorsal pedicle with an arteriovenous loop to permit an increased excursion of the latissimus dorsi muscle in patients with exposed implants and present the results of this procedure. Materials and Methods A retrospective review of patients treated with a latissimus free flap with saphenous vein pedicle extension for posterior spinal wounds from 2010 to 2020 were reviewed. Patient charts were reviewed for demographic information including comorbidities, previous spine operations, wound size and location, and postoperative complications including total flap loss, flap dehiscence, and need for secondary surgery. Results Six patients were identified who underwent a total of eight extended pedicle free flaps. Mean age was 64.8 years with a mean follow-up of 12.3 months (range, 6–20 months). Four wounds were in the cervicothoracic region with two wounds in the cervical region. Mean number of previous spine surgeries was 3.5 (range, 2–4). Mean wound size was 189 cm2 with a mean vein graft length of 28 cm. Wound coverage was successful in five of six patients. Major complications occurred in five of six patients. Total flap loss occurred in two patients (33%) and both underwent a second extended latissimus flap from the contralateral side. Three patients developed postoperative flap dehiscence which resolved with regular dressing changes. Conclusion Extended pedicle latissimus flaps are an effective treatment for posterior spine wounds but are associated with a high complication rate, secondary to medically complex patients with multiple prior surgeries. Careful patient selection is critical for success.

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Section: Discussionmentioning

confidence: 88%

Arteriovenous Vascular Loops in Latissimus Free Flap Reconstruction of Cervical and Cervicothoracic Spine Wounds

Cinats

Harley

Loftus

2023

Journal of Hand and Microsurgery

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“… If a bronchopleural fistula is present, consider suture closure utilizing the edge of a muscle flap or another muscle flap (12).  If closure of the thoracic cavity with a single muscle is inadequate, consider using multiple muscle flaps (12,16).  The choice of pedicle flap or free flap is based on the type and length of muscle, the site and size of the thoracic cavity, and patient factors, such as muscle volume or damages due to initial surgery (17).…”

Section: Features Of the Muscle Flap And Details Of The Proceduresmentioning

confidence: 99%

“…When a large muscle flap is harvested, especially in women, scarring can cause arm adduction problems and arm weakness, but these problems have been reported to resolve almost completely within one year after surgery (20,21). As described above, the latissimus dorsi muscle flap is very useful, but it should be noted that it cannot be used if a posterolateral incision is made during the initial surgery and the latissimus dorsi muscle is dissected (12,14,16,(22)(23)(24)(25).…”

Section: Latissimus Dorsi Musclementioning

confidence: 99%

“…Although the serratus anterior muscle is a respiratory support muscle, no significant decrease in vital capacity (VC) or forced expiratory volume in 1 second (FEV 1 ) was observed from before to after surgery, suggesting that the removal of the muscle flap had little effect on respiratory function (34). The serratus anterior muscles and latissimus dorsi muscle can be elevated simultaneously by using the common nutrient vessel, the thoracodorsal vessel branch (13), and radical cure of empyema after pneumonectomy with a combined latissimus dorsi-serratus anterior muscle flap has also been reported (16,35).…”

Section: Serratus Anterior Musclementioning

confidence: 99%

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Second surgery for complications of major pulmonary resection—the technique of thoracoplasty with muscle flap

Azuma¹

2023

Shanghai Chest

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Second surgery for postoperative complications after lung resection is one of the important issues that thoracic surgeons must overcome. Chronic empyema after lung resection, which is caused by bronchopleural or pleural fistula remains a challenge in modern medicine. Especially in cases in which decortication is not indicated, treatment is difficult, hospitalization is prolonged, and the condition is sometimes life-threatening. Surgical treatment of chronic empyema requires not only decortication and debridement, but also closure of the bronchopleural fistula and obliteration of dead space. From this viewpoint, thoracoplasty and muscle flap transposition are important techniques that lead to complete and reliable closure of the empyema cavity. Although they are performed less frequently today, they are procedures with which every thoracic surgeon should be familiar. This clinical practice review focuses on the use of muscle flaps in thoracoplasty and describes the historical background, types of muscle flaps, tips on surgical techniques, and treatment results. There is a wide variety of types and utilization of muscle flaps.Since the selection of an appropriate muscle flap is directly related to the success of the treatment, careful preoperative planning is necessary. It is important to understand the characteristics of each type of muscle flap and to select the appropriate technique for the patient's pathological and general condition.

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Conjoint muscle free flap for obliteration of an upper thoracic empyema cavity

Cited by 2 publications

References 9 publications

Arteriovenous Vascular Loops in Latissimus Free Flap Reconstruction of Cervical and Cervicothoracic Spine Wounds

Arteriovenous Vascular Loops in Latissimus Free Flap Reconstruction of Cervical and Cervicothoracic Spine Wounds

Second surgery for complications of major pulmonary resection—the technique of thoracoplasty with muscle flap

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