Treatment of Total Sternal Necrosis Using the Latissimus Dorsi Muscle Flap

Tizian, C; Borst, H. G.; Berger, A

doi:10.1097/00006534-198511000-00008

Cited by 43 publications

(14 citation statements)

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“…Pectoralis major muscle flap is apparently preferred for central defects in cases with sternal osteomyelitis or mediastinitis. [10] In our cases, contrary to literature data, following reconstruction of lesions localized in infraclavicular region, remaining segment of pectoralis muscle was transferred over acromioclavicular artery to infraclavicular region. [11] When defect extended beyond middle third of segment and pectoralis muscle was not sufficient to close the defect per se, latissimus dorsi muscle flap was also used to achieve durable reconstruction.…”

Section: Discussioncontrasting

confidence: 63%

Multidisciplinary Approach and Clinical Algorithm in Resection and Reconstruction for Chest Wall Tumor

Demirhan¹

2017

South Clin Ist Euras

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Objective: The aim of this study was to retrospectively review files of patients who had tumor resection and reconstructive surgery performed by thoracic and plastic surgeons due to chest wall tumor, and to create reconstruction algorithm. Methods:Records of 45 patients who underwent surgery for chest wall tumor between 2006-2014 were included in this study. Data including age, sex, tumor localization, defect size, quantity of resected costa and bone, and method of skeletal and soft tissue reconstruction were gathered retrospectively from patient files. Results:The largest defect was 325 cm 2 and smallest was 36 cm 2 . Titanium mesh was used in 54% of patients, while prolene mesh was used in 32%. Pectoralis kite flap (n=14), latissumus dorsi muscle-skin muscle flap (n=12), latissumus dorsi muscle flap and pectoral kite flap (n=5), vertical rectus abdominus skin muscle flap (n=6), omentum flap (n=3), transvers rectus abdominus skin muscle flap (n=3), free anterolateral thigh flap (n=2), and local rotation flap (n=1) were used for soft tissue reconstruction. Conclusion:Algorithm for soft and skeletal tissue reconstruction was created in accordance with obtained data.

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Section: Discussioncontrasting

confidence: 63%

Multidisciplinary Approach and Clinical Algorithm in Resection and Reconstruction for Chest Wall Tumor

Demirhan¹

2017

South Clin Ist Euras

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“…Our suggested schema (Table 1) is biased toward maximal utilization of the pectoralis major and rectus abdominis muscles with which we are most familiar. Other rarely chosen alternatives include the latissimus dorsi (16) or external oblique (6) muscles, or omentum which requires a laparatomy (1,3,17).…”

Section: Resultsmentioning

confidence: 99%

Management of the recurrent sternal wound infection

Hallock¹

1995

CAN J PLAST SURG

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GG Hallock. Management of the recurrent sternal wound infection. Can J Plast Surg 1995;3(3):127-132. After adequate sternal debridement or resection for the treatment of a sternal wound infection, muscle flap obliteration of the resulting void has become an accepted standard. Unfortunately, recurrence is not an inconsequential risk as evidenced in six (20.7%) of our patients over the last 10 years. Two of these patients required a second muscle flap transfer before obtaining a healed wound. Since the available regional options for appropriate vascularized flaps is limited, especially with the increased frequency in use of the internal mammary artery for coronary artery bypass grafting, great care must be observed in the selection process not just for closure of the initial wound, but in anticipation of untoward sequela. A schema prioritizing alternatives has been established, so as to maximize the benefit of our workhorse flaps, the pectoralis major or rectus abdominis muscles. Key Words: Median sternotomy, Muscle flaps, Sternal wound infectionTraitement de l'infection récidivante d'une plaie au sternum RÉSUMÉ: Après un débridement ou une résection sternale adéquate pour le traitement d'une infection de plaie sternale, l'oblitération du lambeau musculaire est devenue une norme acceptée. Malheureusement, la récurrence n'est pas un risque bénin, comme en font foi six de nos cas (20,7 %) échelonnés sur dix ans. Deux de ces patients ont nécessité un nouveau lambeau musculaire pour obtenir une cicatrisation. Étant donné que le choix de lambeaux adéquatement vascularisés est limité, et particulièrement compte tenu de la fréquence accrue d'utilisation de l'artère mammaire interne pour les interventions de chirurgie cardiaque, il faut choisir l'intervention avec grand soin, non seulement pour ce qui est de la fermeture de la plaie initiale, mais pour prévenir toute séquelle indésirable. Un schéma établissant des solutions de rechange a été mis sur pied pour maximiser les avantages de nos principaux lambeaux, le grand pectoral et le grand droit de l'abdomen.The incidence of sternal wound infection following cardiothoracic surgery is relatively miniscule, and certainly not in excess of the general rate of wound infection after most elective operations (1). Unfortunately, for those so afflicted, this can be a devastating problem due to risks of generalized sepsis, uncontrolled hemorrhage or thrombosis, or seeding of prosthetic devices (2,3). Survival has increased over the years paralleling the evolution in treatment from open dressings, closed methods with suction

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“…Large sternal defects associated with partial and total sternotomy have also been covered using the omentum, rectus muscle, and latissimus muscle flap. [7][8][9][10] Muscle flaps can be used alone or in combination with sternal rewiring. If complete resection of the sternum is required, reconstruction can become problematic as muscle flaps may not prevent paradoxical chest wall movement, and thoracic instability may occur necessitating prolonged ventilatory support, which increases the risk of complications such as pneumonia, thrombosis, and muscle weakening.…”

Section: Techniquementioning

confidence: 99%

Longitudinal plate fixation technique after gross resection of the sternum or multiple sternal fracture

Taşoğlu¹

2013

Turk Gogus Kalp Dama

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Bu yazıda komplike sternal kapamalarda alternatif bir yol olarak longitudinal plak fiksasyonu tekniği kullanımı tanımlandı. Ocak 2008 -Eylül 2011 tarihleri arasında sternotomi sonrası longitudinal rijit plak fiksasyonu yapılan hastalar retrospektif olarak değerlen-dirildi. Sternum debridmanı sonrası tama yakın sternal kaybı olan ya da çoklu sternal kırığı bulunan yedi hasta (3 erkek, 4 kadın; ort. yaş 64.42 yıl; dağılım 30-74 yıl) sternal ayrılma için yüksek riskli olarak tanımlandı. Sternal kaynamaması olan bu hastalarda 10 kez tekrar longitudinal plak fiksasyonu uygulandı. Hastaların ikisinde (%29) tama yakın sternal kayıp, beşinde (%71) ise çoklu sternal kırık vardı. Sternal instabilitesi olan bu hastalar ön göğüs duvarında titanyum plaklar ve çelik teller kullanılarak ameliyat edildi. Uzun dönemde çok az rahatsızlık hissinin dışında, bütün hastalarda ameliyat sonrası göğüs ağrısı kayboldu. Tama yakın sternal kayıp olgularında ve çoklu sternal kırıklarda, longitudinal sternal plak ve çelik tellerin kullanımı efektif bir seçenektir. Kullanımı kolay olan bu teknik, daha az komplikasyonla da ilişkilidir.Anah tar söz cük ler: Ayrılma; fiksasyon; plak; sternum.In this article, we described an alternative way for complicated sternal closure by using a longitudinal plate fixation technique. A retrospective analysis between January 2008 and September 2011 was performed on patients who received primary longitudinal rigid plate fixation after sternotomy. Seven patients (3 males, 4 females; mean age 64.4±14.3 years; range 30 to 74 years) with multiple sternal fractures or near-total loss after sternal debridement were defined as having high-risk for sternal dehiscence. We performed 10 longitudinally sternal plate refixation in these patients with sternal nonunion. Two patients (29%) had near-total sternal loss, while five patients (71%) had multiple sternal fractures. The patients suffering from sternal instability were operated using the titanium plates and steel wires for the anterior chest wall. Postoperative chest pain disappeared in all patients with only minor discomfort in the long-term. Longitudinal sternal plating and steel wires are an effective option for the treatment in patients with near-total sternal loss and multiple sternal fractures. This technique which is easy to use seems to be associated with fewer complications.

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Treatment of Total Sternal Necrosis Using the Latissimus Dorsi Muscle Flap

Cited by 43 publications

References 0 publications

Multidisciplinary Approach and Clinical Algorithm in Resection and Reconstruction for Chest Wall Tumor

Multidisciplinary Approach and Clinical Algorithm in Resection and Reconstruction for Chest Wall Tumor

Management of the recurrent sternal wound infection

Longitudinal plate fixation technique after gross resection of the sternum or multiple sternal fracture

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