The Role of the Internal Thoracic Artery in the Sternal Blood Supply

Knudsen, Finn Ursin; Andersen, Martin J.; Niebuhr, U; Nielsen, P L; Krag, Christen

doi:10.3109/14017439309099086

Cited by 15 publications

(11 citation statements)

References 11 publications

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“…Studies and experiments investigating the anatomy of the internal thoracic artery in human cadavers have demonstrated its role in the blood supply of the sternum, and support the suggestion that impaired sternal healing may be due to ischaemia [22][23][24][25]. Animal models of the postoperative sternum, where flow has been studied using radiolabelled micro-spheres, also support this hypothesis [26][27][28].…”

Section: Ischaemic Sternal Osteomyelitismentioning

confidence: 70%

The role of hyperbaric oxygen therapy in the treatment of sternal wound infection

Mills

Bryson²

2006

European Journal of Cardio-Thoracic Surgery

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Sternal wound dehiscence and infection are major problems for patients and health care providers. A range of risk factors, including diabetes, obesity and internal thoracic artery harvest, has been implicated. Several pathophysiological mechanisms, which may account for the development of infection, have been proposed. There is a growing body of evidence which suggests that sternal ischaemia may play a significant role in the initiation of wound infection, and that this may be exacerbated by harvest of the internal thoracic artery. Current treatments for infection include wound debridement, irrigation and tissue flap reconstruction. In addition, several novel therapies such as negative pressure dressings have been shown to be safe and useful. Hyperbaric oxygen therapy - the administration of 100% oxygen at pressures greater than atmospheric pressure - is widely used in the treatment of various chronic wounds. The mechanism whereby hyperbaric oxygen exerts its effects is being elucidated and there is a growing body of clinical evidence that supports its use. It has been suggested that there may be a role for hyperbaric oxygen therapy in the treatment of sternal infection. The theoretical mechanisms would seem plausible, but at present there is only limited evidence to support its use. This review addresses the theory and evidence supporting the role of hyperbaric oxygen therapy in the treatment of sternal wound infection.

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Section: Ischaemic Sternal Osteomyelitismentioning

confidence: 70%

The role of hyperbaric oxygen therapy in the treatment of sternal wound infection

Mills

Bryson²

2006

European Journal of Cardio-Thoracic Surgery

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“…BILATERAL IMA GRAFTS. Given that the IMA is a major blood supply to the sternum, some studies report mobilization of these arteries may lead to sternal hypoperfusion and increase the risk of sternal infection [60][61][62][63][64][65][66]. However, other studies have disputed this argument, reporting no association between the use of bilateral IMA grafts and the incidence of sternal infection [7,63,64,67].…”

Section: Perioperative Risk Factor For Sternal Infectionmentioning

confidence: 99%

Risk Factors for Sternal Complications After Cardiac Operations: A Systematic Review

Balachandran

Lee

Denehy

et al. 2016

The Annals of Thoracic Surgery

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Early detection of patients at risk of sternal complications is essential to facilitate prevention and optimize timely intervention. A systematic review and meta-analysis was conducted to identify risk factors associated with sternal complications. The review included 17 full-text studies, of which 10 were entered into meta-analyses. Female gender, diabetes mellitus, obesity, bilateral internal mammary artery grafts, reoperation for postoperative complications, and blood product requirement were reported as significant predictors of sternal infection. The compilation of these risk factors may help to screen and stratify patients at risk of impaired sternal healing and warrants further investigation.

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“…Furthermore, 5–14% of patients report chest wall contour abnormalities, characterised by visible depression on the medial chest wall [11–14] . In addition, with this more conventional approach the risk of pneumothorax, impaired vascularisation of the sternum and intercostal neuralgia may be increased [5,15–19] .…”

Section: Introductionmentioning

confidence: 99%

Total ‘rib’-preservation technique of internal mammary vessel exposure for free flap breast reconstruction: A 5-year prospective cohort study and instructional video

Rosich-Medina

Bouloumpasis

Candia

et al. 2015

Annals of Medicine &Amp; Surgery

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IntroductionThe total ‘rib’-preservation method of dissecting out the internal mammary vessels (IMV) during microvascular breast reconstruction aims to reduce free flap morbidity at the recipient site. We review our five-year experience with this technique.Patients & methodsAn analysis of a prospectively collected free flap data cohort was undertaken to determine the indications, operative details and reconstructive outcomes in all breast reconstruction patients undergoing IMV exposure using the total ‘rib’-preservation method by a single surgeon.Results178 consecutive breast free flaps (156 unilateral, 11 bilateral) were performed from 1st June 2008 to 31st May 2013 in 167 patients with a median age of 50 years (range 28–71). There were 154 DIEP flaps, 14 SIEA flaps, 7 muscle-sparing free TRAMs, 2 IGAP flaps and one free latissimus dorsi flap. 75% of the reconstructions (133/178) were immediate, 25% (45/178) were delayed. The mean inter-costal space distance was 20.9 mm (range 9–29). The mean time taken to expose and prepare the recipient IMV's was 54 min (range 17–131). The mean flap ischaemia time was 95 min (range 38–190). Free flap survival was 100%, although 2.2% (4 flaps) required a return to theatre for exploration and flap salvage. No patients complained of localised chest pain or tenderness at the recipient site and no chest wall contour deformity has been observed.Discussion & conclusionThe total ‘rib’-preservation technique of IMV exposure is a safe, reliable and versatile method for microvascular breast reconstruction and should be considered as a valid alternative to the ‘rib’-sacrificing techniques.

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The Role of the Internal Thoracic Artery in the Sternal Blood Supply

Cited by 15 publications

References 11 publications

The role of hyperbaric oxygen therapy in the treatment of sternal wound infection

The role of hyperbaric oxygen therapy in the treatment of sternal wound infection

Risk Factors for Sternal Complications After Cardiac Operations: A Systematic Review

Total ‘rib’-preservation technique of internal mammary vessel exposure for free flap breast reconstruction: A 5-year prospective cohort study and instructional video

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