Unilateral pectoralis major muscle flap for the treatment of sternal wounds due to Ludwig's angina

Neto, Antonio Vieira da Silva; Coltro, Pedro Soler; Horácio, Grazielle Souza; Almeida, Ivan R; Farina, Jayme Adriano

doi:10.1111/iwj.12844

Cited by 7 publications

(8 citation statements)

References 19 publications

(28 reference statements)

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“…It was observed in the study by Wang et al, in which the authors performed most of the reconstructions using the unilateral technique (20 in 23 cases), 1 and by other studies 10 . In 2018, our group also report the use of the unilateral pectoralis major muscle flap for the treatment of sternotomy dehiscence in a patient with mediastinitis due to Ludwig's angina 11 …”

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confidence: 62%

The role of the unilateral pectoralis major muscle flap in the treatment of deep sternal wound infection and dehiscence

Coltro

Farina

2022

Journal of Cardiac Surgery

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Deep sternal wound infection and dehiscence has been classified as complex wound, and its treatment is a challenge for the surgeon. There are many flap choices for its treatment, each one having advantages and drawbacks. The article by Wang et al.evidenced that the unilateral pectoralis major muscle flap is a simple and effective option for wound closure resulting from sternotomy dehiscence in infants and children. The report discussed herein highlights that the unilateral pectoralis major muscle flap has been a good and feasible option for the reconstruction of the sternal wound in adults, as previously described by our group and other authors. This technique presents low morbidity and acceptable esthetic and functional results, providing stability to the sternal region.

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confidence: 62%

The role of the unilateral pectoralis major muscle flap in the treatment of deep sternal wound infection and dehiscence

Coltro

Farina

2022

Journal of Cardiac Surgery

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“…It is still being investigated whether the PM muscle flap instead of the myocutaneous flap could reduce the nipple displacement and avoid skin graft on the rib cage. Although the unilateral (Albacete Neto et al, 2018) or bilateral advancement (Lee et al, 2010) and turn‐over (Sano et al, 2005) PM muscle flaps were considered an alternative for sternal wound reconstruction, we prefer to use these options on patients with unstable but sufficient sternum (i.e., AMSTERDAM classification grade 3). For grade 4 complications (unstable and insufficient sternum) in our series, advancement of PM muscle flap with primary skin closure was inadequate, and the subsequent skin grafting was inevitable.…”

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confidence: 99%

Free extended anterolateral thigh myocutaneous flap versus combined pedicled pectoralis major–latissimus dorsi myocutaneous flaps in deep and extensive sternal wound reconstruction

et al. 2022

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Background The combined pedicled pectoralis major‐latissimus dorsi (PM–LD) and free extended anterolateral thigh (ALT) myocutaneous flaps provide well‐vascularized tissues for extensive sternal wound reconstruction. However, the outcomes and postoperative complications between the two surgical techniques are different. Thus, the aim of this study is to evaluate the feasibility of these two reconstructive options. Methods This single‐center, retrospective study was conducted between August 2011 and May 2019. Forty‐four patients diagnosed with deep sternal wound infection (DSWI) and presented with grade four complications (sternal instability and necrotic bone tissue) were enrolled. Two reconstructive strategies, namely, combined pedicled PM–LD (n = 24) and free extended ALT (n = 20) myocutaneous flaps, were used according to the patients' hemodynamics. Data including age, gender, body mass index (BMI), hospital stay, follow‐up, defect/flap size, number of surgical procedures before reconstruction, duration from the last debridement to flap coverage, comorbidities, and postoperative complications, were obtained for statistical analysis. Results The mean defect size in the combined PM–LD myocutaneous flap group was 188.4 (5*17–10*23) cm2, and the mean flap size was 150.0 (8*12–15*15) cm2 and 205.0 (8*15–10*25) cm2 in PM and LD flap, respectively. The mean defect size in the free extended ALT myocutaneus flap group was 202.5 (6*16–10*21) cm2, and the mean flap size was 285.2 (9*30–12*25) cm2. No significant differences were observed between the free extended ALT and the combined pedicled PM–LD myocutaneous flaps in relation to age, gender, BMI, hospital days, follow‐up, defect size, preoperative procedures, and comorbidities, except for the average operative time (443.2 ± 31.2 vs. 321.3 ± 54.3 mins, p = .048). The combined pedicled PM–LD myocutaneous flap had significantly more donor site complications, including seroma (21% vs. 0%, p = .030), bilateral nipple–areolar complex asymmetry (100% vs. 0%, p < .0001), and skin graft loss with infection (33% vs. 0%; p = .044) than the free extended ALT myocutaneous flap. Conclusion The free extended ALT and the combined pedicled PM–LD myocutaneous flaps were both feasible and effective options for sternal wound reconstruction. Our findings suggested that the free extended ALT myocutaneous flap may be a better alternative for a comprehensive and extensive reconstruction of sternal wounds. Further studies based on these findings can be conducted.

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“…DNM is a rare but fatal complication of odontogenic or pharyngeal infection, such as Ludwig’s angina, which is an infection of the submandibular space, usually secondary to infection of the second or third lower molar ( 7 ). These infections spread along the deep fascial spaces down to the mediastinum via the loose anatomical structures, such as the pretracheal space, perivascular space, and prevertebral space ( 3 ).…”

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confidence: 99%

Management of descending necrotizing mediastinitis with severe thoracic empyema using minimally invasive video-assisted thoracoscopic surgery: a case report

Zhang¹,

Wang²,

Xin³

et al. 2022

Transl Pediatr

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Background: Descending necrotizing mediastinitis (DNM) is a rare but serious complication of odontogenic or pharyngeal infection spreading into the mediastinum. Very few childhood cases of DNM have been described. Case Description:We report a case of DNM complicated with severe thoracic empyema in a previously healthy 6-year-old girl who was successfully treated using minimally invasive video-assisted thoracoscopic surgery (VATS). The patient presented with odynophagia and dental pain, followed by rapid clinical deterioration including high fever, tachypnea, and left chest pain. As chest computed tomography (CT) revealed features of DNM, she was transferred from the local hospital to our hospital for intensive care.Empirical treatment was started with meropenem and linezolid. However, her tachypnea and dyspnea progressed rapidly. An ultrasound-guided left-sided thoracentesis drained 80 mL of brown sticky pus and the pus culture yielded Streptococcus constellatus. A contrast-enhanced CT scan demonstrated large mediastinal abscess and severe thoracic empyema. We performed debridement and drainage of the mediastinum and pleura using VATS. She recovered and was discharged on hospital day 18.Conclusions: Early diagnosis by cervicothoracic CT and multidisciplinary approaches including intensive care, broad-spectrum antibiotics, and aggressive surgical intervention are crucial to reducing morbidity and mortality. VATS is a minimally invasive and appropriate treatment strategy for children with DNM, especially complicated with thoracic empyema.

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Unilateral pectoralis major muscle flap for the treatment of sternal wounds due to Ludwig's angina

Cited by 7 publications

References 19 publications

The role of the unilateral pectoralis major muscle flap in the treatment of deep sternal wound infection and dehiscence

The role of the unilateral pectoralis major muscle flap in the treatment of deep sternal wound infection and dehiscence

Free extended anterolateral thigh myocutaneous flap versus combined pedicled pectoralis major–latissimus dorsi myocutaneous flaps in deep and extensive sternal wound reconstruction

Management of descending necrotizing mediastinitis with severe thoracic empyema using minimally invasive video-assisted thoracoscopic surgery: a case report

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