Workhorse Flaps in Chest Wall Reconstruction: The Pectoralis Major, Latissimus Dorsi, and Rectus Abdominis Flaps

Bakri, Karim; Mardini, Samir; Evans, Karen K.; Carlsen, Brian T.; Arnold, Phillip G.

doi:10.1055/s-0031-1275170

Cited by 81 publications

(86 citation statements)

References 25 publications

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“…As in previous studies, abdominal flap has been used to reconstruct various chest wall defects ; pedicled full‐thickness abdominal flap was eventually used to cover the extensive anterior chest wall defect following major electrical burn in this study, as this flap is easy to design and harvest with adequate blood supply. On the other hand, the best time to perform the operation is another important factor.…”

Section: Discussionmentioning

confidence: 96%

Pedicled full‐thickness abdominal flap combined with skin grafting for the reconstruction of anterior chest wall defect following major electrical burn

Zhao

Xian

et al. 2013

International Wound Journal

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Successful reconstruction of extensive anterior chest wall defect following major electrical burn represents a very challenging surgery. Herein we report the first case using pedicled full-thickness abdominal flap combined with skin grafting to treat this injury with severe infection and exposure of pericardium and ribs in a Chinese patient. Following the performance of chest debridement to remove necrotic and infected tissues and the injection of broad-spectrum antibiotics to reduce infection, a pedicled full-thickness abdominal flap was used to cover the exposed pericardium and ribs, and skin grafting from the right leg of the patient was done to cover the exposed vital tissues. The patient was followed up for a total of 3·5 years, and satisfactory cosmetic and functional outcomes were obtained without complications. This report provides an effective method for the surgeons who encounter similar cases where reconstruction of extensive anterior chest wall is required.

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Section: Discussionmentioning

confidence: 96%

Pedicled full‐thickness abdominal flap combined with skin grafting for the reconstruction of anterior chest wall defect following major electrical burn

Zhao

Xian

et al. 2013

International Wound Journal

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“…For reconstruction of the chest wall defects, the most commonly used muscles are latissimus dorsi and pectoralis major;[7] sometimes, omentum is also used. [3] However, in our case, there was deep second-degree burn on the back, thus precluding use of latissimus dorsi muscle flap.…”

Section: Discussionmentioning

confidence: 99%

Extensive chest wall tissue loss and its management by vertical rectus abdominis myocutaneous flap

Basu

Bain

Chattopadhyay

et al. 2017

J Indian Assoc Pediatr Surg

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Extensive electric burn around the chest in children is rare and this type of injury always poses a great challenge for its management. A 12-year-old male child with extensive electric burn of the chest wall was admitted to hospital. It was a neglected case of 9 days old burn; the young boy was in critical condition having systemic features of toxemia with widespread necrosis of the skin, subcutaneous tissues, and muscles along with exposed bones (ribs and sternum) with the risk of impending rupture of pleura through the exposed intercostal spaces. After initial resuscitation, a thorough debridement of all necrotic tissues was done. Thereafter, a superiorly based vertical rectus abdominis myocutaneous flap was harvested to cover the exposed bones and intercostal spaces. The remaining raw areas were skin grafted. The child made an excellent recovery with good outcome.

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“…A 2002 study also showed that one-stage debridement and reconstruction is better than conventional repair techniques [18]. Among the most commonly used donor sites for chest wall reconstruction are the pectoralis major and rectus abdominis as either muscle or myocutaneous flaps [19]. Immediate debridement combined with pectoralis major flap has been shown to minimize morbidity and mortality [20].…”

Section: Discussionmentioning

confidence: 99%

Cross-sectional area of the abdomen predicts complication incidence in patients undergoing sternal reconstruction

Kozlow

Lisiecki

Terjimanian

et al. 2014

Journal of Surgical Research

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Background Sternal reconstruction with vascularized flaps is central to the management of sternal wound infections and mediastinitis but carries a high risk of complications. There is a need to identify reliable predictors of complication risk to help inform patients and clinicians in preparation for surgery. Unfortunately, body mass index and serum albumin may not be reliable predictors of complication rates. Analytic morphomics provides a robust quantitative method to measure patients’ obesity as it pertains to their risk of complications in undergoing sternal reconstruction. Methods We identified 34 patients with preoperative computed tomography scans of the abdomen from a cohort of sternal reconstructions performed between 1997 and 2010. Using semiautomated analytic morphomics, we identified the patients’ skin and fascia layers between the ninth and 12th thoracic spine levels; from these landmarks, we calculated morphomic measurements of the patients’ abdomens, including their total body cross sectional area and the cross sectional area of their subcutaneous fat. We obtained the incidence of complications from chart review and correlated the incidence of complications (including seroma, hematoma, recurrent wounds, mediastinitis, tracheostomy, and death) with patients’ morphomic measurements. Results Sixty-two percent of patients (n = 21) suffered complications after their operation. Those who suffered from complications, relative to those who did not have complications, had increased visceral fat area (12,547.2 mm2 versus 6569.9 mm2, P = 0.0080), subcutaneous fat area (16,520.2 mm2 versus 8020.1 mm2, P = 0.0036), total body area (91,028.6 mm2 versus 67,506.5 mm2, P = 0.0022), fascia area (69,238.4 mm2 versus 56,730.9 mm2, P = 0.0118), total body circumference (1101.8 mm versus 950.2 mm, P = 0.0017), and fascia circumference (967.5 mm versus 868.1 mm, P = 0.0077). We also demonstrated a significant positive correlation between the previously mentioned morphomic measurements and the incidence of complications in multivariate logistic regression models, with odds ratios ranging from 1.19–3.10 (P values ranging from 0.010–0.022). Conclusions Increases in abdominal morphomic measurements correlate strongly with the incidence of complications in patients undergoing sternal reconstruction. This finding may influence preoperative risk stratification and surgical decision making in this patient population.

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Workhorse Flaps in Chest Wall Reconstruction: The Pectoralis Major, Latissimus Dorsi, and Rectus Abdominis Flaps

Cited by 81 publications

References 25 publications

Pedicled full‐thickness abdominal flap combined with skin grafting for the reconstruction of anterior chest wall defect following major electrical burn

Pedicled full‐thickness abdominal flap combined with skin grafting for the reconstruction of anterior chest wall defect following major electrical burn

Extensive chest wall tissue loss and its management by vertical rectus abdominis myocutaneous flap

Cross-sectional area of the abdomen predicts complication incidence in patients undergoing sternal reconstruction

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