Omentum Flap versus Pectoralis Major Flap in the Treatment of Mediastinitis

López-Monjardin, Homero; de-la-Peña-Salcedo, Abel; Mendoza-Muñoz, M; López-Yáñez-de-la-Peña, Arturo; Palacio-López, Edgardo; López‐García, Alejandro

doi:10.1097/00006534-199805000-00008

Cited by 87 publications

(74 citation statements)

References 3 publications

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“…O grande epíploon, por sua eficiente propriedade em combater infecções, assim como sua reconhecida capacidade angiogênica (42) , capaz de suportar um enxerto de pele em sua superfície (43) , aliada à facilidade de obtenção e à possibilidade de obliterar grandes espaços "mortos" nos impulsionou a utilizá-lo como retalho.…”

Section: Comentáriosunclassified

Mediastinite em cirurgia cardíaca: tratamento com epíploon

Sampaio¹,

Alves²,

Silva³

et al. 2000

Rev Bras Cir Cardiovasc

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A cirurgia cardíaca não foge à regra. Apesar de ser sofisticado método de tratamento invasivo, observamos a ocorrência de quadros infecciosos gravíssimos que desafiam a competência da equipe cirúrgica e dos centros de tratamento cardiológico.A abertura do esterno para possibilitar o acesso ao coração, introduzida por MILTON (1,2) , em 1897, e popularizada por JULIAN (3) et al., tem sido evitada sempre que possível. Lança-se mão de procedimentos cardiológicos invasivos com cateteres ou balões (4) e, ultimamente, de abordagens cirúrgicas através de reduzidas incisões torácicas com ou sem o auxílio de videotoracoscopia (5)(6)(7)(8)(9)(10)(11) , com excelentes resultados.A incidência de mediastinite nos procedimentos operatórios cardíacos em que se pratica esternotomia é pequena, variando de 0,4 a 5% (12,13) . A mortalidade desta temível complicação, no entanto, é alta, variando de 14 a 47% (14) . Além desta alta mortalidade, verifica-se considerável aumento dos custos do tratamento após esta complicação, quase triplicando estes valores (15,16) .Os fatores de risco parecem ser muitos, podendo ser citados: associação de diabete melito e

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Section: Comentáriosunclassified

Mediastinite em cirurgia cardíaca: tratamento com epíploon

Sampaio¹,

Alves²,

Silva³

et al. 2000

Rev Bras Cir Cardiovasc

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“…[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] The principal indications for chest wall reconstruction are tumor (primary or recurrent), 5 infection, radiation injury, and trauma, and the particularly unfortunate patient may have any combination of the above. 23 A thorough knowledge of anatomy is the foundation for a clear operative plan and fallback procedure.…”

Section: Abstract: Chest Wall Reconstructionmentioning

confidence: 99%

“…[16][17][18][19][20][21] The pectoralis major muscle is a fan-shaped muscle that covers the anterior superior portion of the chest and forms the anterior axillary fold, attaching proximally to the medial half of the clavicle, sternum, and the superior six costal cartilages and distally to the intertubercular groove of the humerus (Fig. 4).…”

Section: Musculaturementioning

confidence: 99%

Introduction to Chest Wall Reconstruction: Anatomy and Physiology of the Chest and Indications for Chest Wall Reconstruction

Clemens

Evans

Mardini

et al. 2011

Seminars in Plastic Surgery

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The chest wall functions as a protective cage around the vital organs of the body, and significant disruption of its structure can have dire respiratory and circulatory consequences. The past several decades have seen a marked improvement in the management and reconstruction of complex chest wall defects. Widespread acceptance of muscle and musculocutaneous flaps such as the latissimus dorsi, pectoralis major, serratus anterior, and rectus abdominis has led to a sharp decrease in infections and mortality. Successful reconstructions are dependent upon a detailed knowledge of the functional anatomy and blood supply of the chest and the underlying pathophysiology of a particular disease process. This article will provide an overview of key principles and evidence-based approaches to chest wall reconstruction. KEYWORDS: Chest wall reconstructionThe complex interplay of 12 paired ribs with the internal and external muscles that compose the chest wall has both a structural and a functional role. The chest wall protects the heart, lungs, and liver, provides a flexible skeletal framework to stabilize the actions of the shoulder and arm, and promotes respiratory movement all while reliably delivering more than 20,000 breaths a day. Chest wall dysfunction is associated with significant morbidity and rapid life-threatening consequences. Management and reconstruction of complex chest wall defects has significantly improved over the past half century with long-term success rates improved from 50% to the current 90 to 99% and hospital stays reduced from an average of 84 days to less than 13 days. 1-6 A focus on anatomy and blood supply has led to the development of muscle and musculocutaneous flaps and the expanded use of prosthetic materials where appropriate. Knowledge of the functional anatomy and pathophysiology of the chest is essential to the success of the reconstructive chest surgeon. This article focuses on chest anatomy and function, with emphasis on the indications and essential principles of chest wall reconstruction.The study of the thoracic wall and its muscles, vessels, and nerves has been significantly advanced since the end of the past century by anatomic data and classification. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] The principal indications for chest wall reconstruction are tumor (primary or recurrent), 5 infection, radiation injury, and trauma, and the particularly unfortunate patient may have any combination of the above. 23 A thorough knowledge of anatomy is the foundation for a clear operative plan and fallback procedure. We will review the important anatomic considerations that are required for normal chest wall function. RELEVANT CHEST WALL ANATOMY SkeletonThe skeleton of the thoracic wall is formed by the spinal column and 12 thoracic vertebrae posteriorly, the sternum anteriorly, and bounded by 12 paired ribs and costal cartilages (Fig. 1). 7 Within the anterior thorax, the first seven pairs of ribs are attached to the sternum, the 8th through 10th ribs are attached t...

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“…It has good vascularity, lymphatic vessels that can absorb exudates rapidly, and immunological and biological attributes, including cellular proliferation and fibrous tissue formation. It is therefore associated with fewer infective complications than the pectoralis major flap alone [10].…”

Section: Omental Flapmentioning

confidence: 99%

“…While most advocate the use of pedicled muscle or musculocutaneous flaps as the first choice and an omental flap only as a "life boat", others prefer to use the omental flap initially as proposed by Lopez-Monjardin et al [10].…”

Section: Introductionmentioning

confidence: 99%

Algorithm for classification and treatment of poststernotomy wound infections

Vlajčić

Žic

Stanec

et al. 2007

Scandinavian Journal of Plastic and Reconstructive Surgery and

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The treatment of sternal wound infection still carries high mortality. Treatment preferences range from more conservative treatments that do not include flaps, to more aggressive reconstructions using different types of flaps, and these could be resolved and standardised using a proper classification with a treatment algorithm. We propose modification of the existing classification, with different proposals for treatment, stressing the importance of the radicality of debridement, and report our results in 31 patients, 24 of whom were well satisfied. Eleven were left with some pain in the chest wall, and eight each with some muscular weakness and less than adequate cosmesis. We would also like to recommend the omental flap as the first choice for selected cases. With our selective approach, we have achieved good functional and aesthetic results with satisfied patients.

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Omentum Flap versus Pectoralis Major Flap in the Treatment of Mediastinitis

Cited by 87 publications

References 3 publications

Mediastinite em cirurgia cardíaca: tratamento com epíploon

Mediastinite em cirurgia cardíaca: tratamento com epíploon

Introduction to Chest Wall Reconstruction: Anatomy and Physiology of the Chest and Indications for Chest Wall Reconstruction

Algorithm for classification and treatment of poststernotomy wound infections

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