Superior epigastric artery perforator flap for reconstruction of deep sternal wound infection

Abstract

Background The treatment of deep wound sternal infection requires loco‐regional pedicled flaps, usually with muscular flaps. Perforator propeller flaps represent the ultimate progress in the history of reconstructive surgery. We report here our experience with the superior epigastric artery perforator (SEAP) flaps to repair sternal defect. Patients and methods Six patients presenting deep sternal wounds infection were treated with SEAP propeller flap, between March 2015 and June 2017. The mean age was 71.5 (range 53–83) years. The mean length and width of the defect were 16.2 × 7 cm (ranging 8–20 × 4–10). An elliptical skin flap pedicled on the SEAP was harvested in the inframammary fold and rotated up to 90° to cover the defect. Results All SEAP flaps achieved a successful entire coverage of the defect. The mean size of the skin paddle of the flap was 20.2 × 7.3 cm (ranging 14–27 × 6–9). All flaps were able to provide a complete sternal wound cover. Venous congestion was present in five cases and adequately treated by leech therapy; necrosis was distal in one case, and interesting the entire superficial flap in two cases but with deep tissues remaining viable and able to cover the mediastinum: an infected flap required revision. Satisfyingly, at 2‐years postoperative follow‐up all‐patients were alive with a successful mediastinal cover. Conclusions The SEAP Perforator propeller flap is an alternative to muscle flaps to achieve treatment of deep and large sternal wound infection.

Perforator-Based Cross Midline Flaps of the Trunk: A Paradigm Shift in Flap Design

“…Table 5 demonstrates 10 studies (30 flaps) in which a contralateral superficial superior epigastric artery perforator flap was used that crossed the midline. 12,26–34 The maximum flap length averaged 21.3 cm (95% CI, 19.4 to 23.2 cm). Weighted by the sample size of each study, the average maximum length of flap was quite similar (22 cm).…”

Axillary Hidradenitis Suppurativa: A Comparison between Two Perforator Flap Reconstructive Approaches after Radical Surgical Management

“…Perforator vessels were identified with an 8-MHz acoustic handheld Doppler (Hadeco ES 100 VX). [42][43][44] Preoperative design was based on the location of these perforators and adapted intraoperatively. We used an elliptical skin flap allowing primary closure of the donor site, oriented in the direction of the perforasome.…”