Sternal osteomyelitis: treatment with rectus abdominis muscle

Iacobucci, John J.; Stevenson, Thomas R.; Hall, Jonathan D.; Deeb, G. Michael

doi:10.1016/0007-1226(89)90013-1

Cited by 37 publications

(26 citation statements)

References 24 publications

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“…Its transfer can also be incriminated as causing shoulder weakness in an additional one-third (7). There has been little discussion of an acknowledged risk of recurrence of sternal infection (Table 3) (5)(6)(7)11,12,14). In our experience, recurrences typically present as the type III wounds of Pairolero and Arnold (6) with chronic draining sinuses usually caused by residual osteomyelitis, costochondritis, or a retained foreign body.…”

Section: Resultsmentioning

confidence: 87%

“…The pectoralis major muscle remains the most versatile choice when based on its dominant thoracoacromial pedicle, although function preservation techniques using turnover (9) or segmental split flaps (10) can be valuable for some smaller defects if the corresponding internal mammary artery has not been violated. Restricted by this same constraint, the rectus abdominis muscle has been important for filling the lower third of these sternotomy defects (11,12), and rarely should be expected to accomplish more, although a vertical musculocutaneous (VRAM) flap version can be extended to reach most wounds in their entirety as a single flap (13).…”

Section: Resultsmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 87%

Section: Resultsmentioning

confidence: 99%

Management of the recurrent sternal wound infection

Hallock¹

1995

CAN J PLAST SURG

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“…The rectus abdominis muscle may be pedicled superiorly in the absence of the internal mammary system by the additional blood supply from the eighth subcostal artery 33 and can easily cover the lower third of the sternum but can also reach as high as the sternal notch. 34 The external oblique muscle originates from the bottom edge of the 6th through 12th ribs and fans out to insert upon the iliac crest, the linea alba, and the pubic and inguinal ligaments (Fig. 8).…”

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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“…Das erlaubt eine gute Auffüllung der Wundhöhle. Ein Nachteil ist, dass es durch den entstehenden Bauchwanddefekt zu einer Bauchwandschwäche in bis zu 20% oder zu abdominellen Hernien in bis zu 10% kommen kann [18]. Aus diesem Grund ist eine äußerst sorgfältige Rekonstruktion der Bauchwand, vor allem kaudal der Linea arcuata, notwendig, gegebenenfalls auch durch Einnähen eines stabilisierenden synthetischen Netzes [16].…”

Section: Musculus-rectusabdominus-lappenunclassified

Plastisch-chirurgische Rekonstruktion von Defekten der Thoraxwand nach onkologischen Resektionen

Riedel

Kremer

Hoffmann

et al. 2007

Chirurg

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In defect reconstruction following radical oncologic resection of malignant chest wall tumors, adequate soft-tissue reconstruction must be achieved along with function, stability, integrity, and aesthetics of the chest wall. The purpose of this retrospective analysis was to evaluate the oncoplastic concept following radical resection of malignant chest wall infiltration with an interdisciplinary approach. Between 1999 and 2005, 36 consecutive patients (nine males, 27 females, mean age 55 years, range 20-78) were treated with resection for malignant tumors of the chest wall. Indications were locally recurrent breast carcinoma (patient n=22), thymoma (n=1), and desmoid tumor (n=1). Primary lesions of the chest wall were spinalioma (n=1), sarcoma (n=7), and non-small-cell lung cancer (n=2). There were distant metastases of colon and cervical cancer in one patient each. Soft-tissue reconstruction was carried out using primary closure (n=1), external oblique flap (n=1), pectoralis major myocutaneous flap (n=3), latissimus dorsi myocutaneous flap (n=18), vertical or transversal rectus abdominis myocutaneous flap (n=9), free tensor fascia lata- flap (n=6), trapezius flap (n=1), serratus flap (n=1), and one filet flap. In 15 reconstructive procedures microvascular techniques were used. An average of 3.4 ribs were resected. Stability of the chest wall was obtained with synthetic meshes. The latissimus dorsi flap is considered the flap of choice in chest wall reconstruction. However, alternatives such as pectoralis major flap, VRAM/TRAM flap, free TFL flap, and serratus flap must also be considered. Low mortality and morbidity rates allow tumor resection and chest wall reconstruction even in a palliative setting.

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Sternal osteomyelitis: treatment with rectus abdominis muscle

Cited by 37 publications

References 24 publications

Management of the recurrent sternal wound infection

Management of the recurrent sternal wound infection

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

Plastisch-chirurgische Rekonstruktion von Defekten der Thoraxwand nach onkologischen Resektionen

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