Second intercostal internal mammary artery perforator (IMAP) fasciocutaneous flap as an alternative choice for the treatment of deep sternal wound infections (DSWI)

Koulaxouzidis, Georgios; Orhun, Arzu; Stavrakis, Themistoklis; Witzel, Christian

doi:10.1016/j.bjps.2015.05.019

Cited by 21 publications

(14 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Indeed, IMAP flaps have been used to repair median sternotomy wounds, chest wall fistula, and upper abdominal wounds. 22 – 26 These studies confirm that the IMAP flap has stable vascularity and is useful. We believe that our method is a useful reconstruction method in cases of large keloids.…”

Section: Discussionsupporting

confidence: 55%

Reconstruction after Anterior Chest Wall Keloid Resection Using Internal Mammary Artery Perforator Propeller Flaps

Ogawa

Ono

Akaishi

et al. 2016

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

Background:It is difficult to completely resect huge anterior chest wall keloids and then close the wound directly. We report here our retrospective analysis of our case series of patients with such keloids who underwent reconstruction with internal mammary artery perforator (IMAP) pedicled propeller flaps and then received postoperative high-dose-rate superficial brachytherapy.Methods:All consecutive patients with large/severe keloids on the anterior chest wall who underwent keloid resection followed by reconstruction with IMAP-pedicled propeller flaps and then high-dose-rate superficial brachytherapy in our academic hospital were identified. All cases were followed for >18 months. Donor site position, perforator pedicle, flap size, angle of flap rotation, complications, and recurrence were documented.Results:There were nine men and one woman. The average age was 37.9 years. The average follow-up duration was 28.7 months. The largest flap was 16 × 4 cm. The dominant perforators of the internal mammary artery were located in the sixth (n = 2), seventh (n = 5), eighth (n = 1), and ninth (n = 2) intercostal spaces. Twelve months after surgery, patients reported marked relief from keloid-associated pain and itching, except in two patients who underwent partial keloid resection; their remaining keloids were still troublesome but after conservative therapies, including steroid ointments/plasters, the keloids gradually ameliorated. Eighteen months after surgery, there was no keloid recurrence or new development of keloids on the donor site.Conclusions:IMAP-pedicled propeller flaps transfer skin tension from the anterior chest wall to the abdomen. Our series suggests that this approach combined with radiation therapy can control keloid recurrence.

show abstract

Section: Discussionsupporting

confidence: 55%

Reconstruction after Anterior Chest Wall Keloid Resection Using Internal Mammary Artery Perforator Propeller Flaps

Ogawa

Ono

Akaishi

et al. 2016

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

show abstract

“…Another option for reconstruction of these defects is the fasciocutaneous flap based on perforator vessels from the internal thoracic artery, as described by Koulaxouzidis et al [ 15 ] . It is a less aggressive therapeutic option, associated with good aesthetic results and preservation of the breath muscles.…”

Section: Discussionmentioning

confidence: 99%

Application of Unilateral Pectoralis Major Muscle Flap in the Treatment of Sternal Wound Dehiscence

Horácio¹,

Coltro²,

Neto³

et al. 2017

Braz J Cardiovasc Surg

View full text Add to dashboard Cite

ObjectiveThis study aims to report the use of the unilateral pectoralis major muscle flap for the treatment of the sternal wound dehiscence.MethodsA retrospective study including patients who underwent unilateral pectoralis major muscle flap was performed for the treatment of sternotomy dehiscence due to coronary artery bypass, valve replacement, congenital heart disease correction and mediastinitis, between 1997 and 2016. Data from the epidemiological profile of patients, length of hospital stay, postoperative complications and mortality rate were obtained.ResultsDuring this period, 11 patients had their dehiscence of sternotomy treated by unilateral pectoralis major muscle flap. The patients had a mean age of 54.7 years, the mean hospital stay after flap reconstruction was 17.9 days (from 7 to 52 days). In two patients, it was necessary to harvest a flap from the rectus abdominis fascia, in association with the pectoralis major muscle flap, to facilitate the closure of the distal wound. In the postoperative period, seroma discharge from the surgical wound was observed in six patients, five reported intense pain (temporary), three had partial cutaneous dehiscence, and two presented granuloma of the incision.ConclusionThe complex wound from sternotomy dehiscences presents itself as a challenge to surgical teams. Treatment should include debridement of necrotic tissue and preferably coverage with well-vascularized tissue. We propose that the unilateral pectoralis major muscle flap is an interesting and low morbidity option for the reconstruction of sternal wound dehiscences, with proper sternum stability and satisfactory functional and aesthetic outcomes.

show abstract

“…Recently, muscle‐sparing perforator flaps that are less invasive than muscle flaps have been developed for sternal defect closure (Koulaxouzidis, Orhun, Stavrakis, & Witzel, ; Mah et al, ; Wettstein et al, ). Because such flaps are fed by the superior epigastric artery or the internal thoracic artery, they cannot be used in patients who undergo harvesting of the internal thoracic artery.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, muscle-sparing perforator flaps that are less invasive than muscle flaps have been developed for sternal defect closure (Koulaxouzidis, Orhun, Stavrakis, & Witzel, 2015;Mah et al, 2009;Wettstein et al, 2014). Because such flaps are fed by the superior epigastric artery or the internal thoracic artery, they cannot be used in protection to underlying vital structures following sternal debridement (Carlesimo et al, 2014), contact debrided tissues, contribute vascularity, and prevent bacterial growth (Banic, Ris, Erni, & Striffeler, 1995).…”

Section: Discussionmentioning

confidence: 99%

Pectoralis major turnover flap based on thoracoacromial vessels for sternal dehiscence

Goishi¹,

Harada²,

Keyama³

et al. 2019

Microsurgery

View full text Add to dashboard Cite

Background Reconstruction of long and deep sternal defects has been challenging. The pectoralis major can be used in the conventional turnover method that requires the internal thoracic vessel. We developed a new turnover pectoralis major flap based on thoracoacromial vessels. The purpose of this report is to present results from 14 patients. Methods Fourteen patients with a mean age of 73.6 years (range, 53–83 years) who had sternal defects underwent reconstruction via this procedure. The defects were caused by mediastinitis and sternal osteomyelitis in six and eight patients, respectively. The internal thoracic artery (ITA) was harvested in two patients. The mean defect size was 2.4 × 15.5 cm (ranging 1–4.3 × 13–18 cm). After elevation of the lateral border of the muscle and ligation of the third to fifth perforators from ITA, the lateral side was turned over and the medial lower portion of the flap was additionally transplanted to the defect. Results The mean flap size was 10.7 × 18 cm (ranging 9–13 × 15–21 cm). For 11 patients, defects healed without any complications. Discharge after flap reconstruction was observed in three patients, two of whom were managed using conservative treatments. Only one patient who needed additional debridement required transplantation of the contralateral pectoral major flap. Conclusions This muscle flap is nourished primarily by the thoracoacromial vessel. The long length and large volume of the muscle flap could be successfully turned over with this procedure even in patients that had their internal thoracic artery sacrificed.

show abstract

Second intercostal internal mammary artery perforator (IMAP) fasciocutaneous flap as an alternative choice for the treatment of deep sternal wound infections (DSWI)

Cited by 21 publications

References 39 publications

Reconstruction after Anterior Chest Wall Keloid Resection Using Internal Mammary Artery Perforator Propeller Flaps

Reconstruction after Anterior Chest Wall Keloid Resection Using Internal Mammary Artery Perforator Propeller Flaps

Application of Unilateral Pectoralis Major Muscle Flap in the Treatment of Sternal Wound Dehiscence

Pectoralis major turnover flap based on thoracoacromial vessels for sternal dehiscence

Contact Info

Product

Resources

About