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Georgiou I, Ioannou CI, Schmidt J, Eschborn J, Mostofizadeh-Haghighi G, Infanger M, Ghods M, Kruppa P. Free Flaps in Sternal Osteomyelitis After Median Sternotomy: A Center's 12-Year Experience. J Reconstr Microsurg 2023; 39:601-615. [PMID: 36693394 DOI: 10.1055/s-0043-1761208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Adequate treatment of deep sternal wound infections (DSWIs) after open thoracic surgery still presents a major challenge. This study retrospectively analyzes the results of a single center's 12-year experience in treating DSWI, with special emphasis on free flap reconstruction. METHODS In this single-center, retrospective study, all patients admitted with the diagnosis of DSWI after open thoracic surgery between 2009 and 2020 were included. A comparative analysis was performed between: (1) pedicled versus free flaps, (2) the center's two workhorse flaps-the pedicled latissimus dorsi (pLD) versus free anterolateral thigh (fALT) flaps, as well as (3) myocutaneous (MC) versus fasciocutaneous (FC) flaps. Primary endpoints were length of hospital stay (LOS) after reconstruction and in-hospital mortality. RESULTS Of a total of 165 patients included, 152 underwent DSWI defect reconstruction with a total of 12 different reconstruction methods. Although the defect size was larger in patients who underwent free flap coverage, and the risk profile in the fALT and FC flap groups was higher, the LOS after reconstruction (in days) did not differ significantly between the groups (pedicled vs. free flaps: 23 vs. 28, p > 0.05; pLD vs. fALT: 24.5 vs. 26, p > 0.05; MC vs. FC flaps: 23 vs. 26, p > 0.05). Also, no significant differences were found in terms of in-hospital mortality when comparing the groups (pedicled vs. free flaps: 11.2 vs. 17.4%, p > 0.05; pLD vs. fALT: 11.5 vs. 12.5%, p > 0.05; MC vs. FC flaps: 12.9 vs. 12.5%, p > 0.05). CONCLUSION With proper patient selection, free tissue transfer is a valuable alternative in the treatment of sternal dehiscence after a DSWI. Furthermore, our data demonstrate that MC flaps are not necessarily superior to FC flaps in the reconstruction of sternal osteomyelitis defects.
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Affiliation(s)
- Iakovos Georgiou
- Department of Plastic, Aesthetic and Reconstructive Microsurgery/Hand Surgery, Hospital Ernst von Bergmann, Potsdam, Germany
| | | | - Jeremias Schmidt
- Department of Plastic, Aesthetic and Reconstructive Microsurgery/Hand Surgery, Hospital Ernst von Bergmann, Potsdam, Germany
| | - Johannes Eschborn
- Department of Plastic, Aesthetic and Reconstructive Microsurgery/Hand Surgery, Hospital Ernst von Bergmann, Potsdam, Germany
| | - Giw Mostofizadeh-Haghighi
- Department of Plastic, Aesthetic and Reconstructive Microsurgery/Hand Surgery, Hospital Ernst von Bergmann, Potsdam, Germany
| | - Manfred Infanger
- Clinic for Plastic, Aesthetic and Hand Surgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Mojtaba Ghods
- Department of Plastic, Aesthetic and Reconstructive Microsurgery/Hand Surgery, Hospital Ernst von Bergmann, Potsdam, Germany
| | - Philipp Kruppa
- Department of Plastic, Aesthetic and Reconstructive Microsurgery/Hand Surgery, Hospital Ernst von Bergmann, Potsdam, Germany
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Song Y, Chu W, Sun J, Liu X, Zhu H, Yu H, Shen C. Review on risk factors, classification, and treatment of sternal wound infection. J Cardiothorac Surg 2023; 18:184. [PMID: 37208736 DOI: 10.1186/s13019-023-02228-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/02/2023] [Indexed: 05/21/2023] Open
Abstract
Sternal wound infection (SWI) is the most common complication of the median sternal incision. The treatment time is long, and the reconstruction is difficult, which causes challenges for surgeons. Plastic surgeons were often involved too late in such clinical scenarios when previous empirical treatments failed and the wound damage was relatively serious. Accurate diagnosis and risk factors against sternal wound infection need to be in focus. Classification of different types of sternotomy complications post-cardiac surgery is important for specific categorization and management. Not familiar with this kind of special and complex wound, objectively increasing the difficulty of wound reconstruction. The purpose of this comprehensive review is to review the literature, introduce various SWI risk factors related to wound nonunion, various classification characteristics, advantages and disadvantages of various wound reconstruction strategies, to help clinicians understand the pathophysiological characteristics of the disease and choose a better treatment method.
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Affiliation(s)
- Yaoyao Song
- Senior Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, No. 51, Fucheng Road, Haidian District, Beijing, 100048, China
| | - Wanli Chu
- Senior Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, No. 51, Fucheng Road, Haidian District, Beijing, 100048, China
| | - Jiachen Sun
- Senior Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, No. 51, Fucheng Road, Haidian District, Beijing, 100048, China
| | - Xinzhu Liu
- Senior Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, No. 51, Fucheng Road, Haidian District, Beijing, 100048, China
| | - Hongjuan Zhu
- Senior Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, No. 51, Fucheng Road, Haidian District, Beijing, 100048, China
| | - Hongli Yu
- Senior Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, No. 51, Fucheng Road, Haidian District, Beijing, 100048, China
| | - Chuan'an Shen
- Senior Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, No. 51, Fucheng Road, Haidian District, Beijing, 100048, China.
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3
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Bundele V, Aggarwal N, Bana A. Large Sternoabdominal Wound Dehiscence after Cardiac Surgery: Challenging Multimodal Treatment. Adv Skin Wound Care 2023; 36:1-5. [PMID: 37079794 DOI: 10.1097/01.asw.0000923312.33600.8e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
ABSTRACT The authors report the case of a patient who presented with a nonhealing sternal wound 3 months after cardiac bypass surgery. The patient was treated with vacuum-assisted closure, surgical debridement, and IV antibiotics. Despite repeated flap closure procedures, a top closure device, and wound dressings, the patient developed an infection, and the wound size increased from 8 × 10 cm to 20 × 20 cm, advancing from the sternal to upper abdominal region. This wound was then treated with hyperbaric oxygen therapy and nonmedicated dressings until the patient was eligible to receive a split-thickness skin graft 1.5 years after initial presentation. The main takeaway from this case was that local and systemic factors affected the outcome of each surgical closure. The failure of each preceding treatment choice that led to further increases in size and area of the wound was the main challenge. Eliminating infection, preventing development of new infection, and managing the local and systemic factors before any definite surgery are key to the eventual wound closure.
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Affiliation(s)
- Varsha Bundele
- At the Eternal Hospital, Jaipur, Rajasthan, India, Varsha Bundele, MBBS, MS, MCh, is Consultant, Plastic and Reconstructive Surgery; Neha Aggarwal, MDS, FCCS, is Consultant, Plastic Surgery Team, Oral and Maxillofacial Surgery; and Ajeet Bana, MBBS, MS, MCh, is Chairman of Cardiac Sciences
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Sugino RL, Iutaka AS, Cho SK, Cataldo DR, Marchi L, Herrero CFPDS. Determinação da capacidade de acesso anterior à coluna cervicotorácica conforme idade e gênero: Análise radiográfica de imagens de tomografia computadorizada. Rev Bras Ortop 2022; 57:61-68. [PMID: 35198110 PMCID: PMC8856854 DOI: 10.1055/s-0041-1740295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/13/2021] [Indexed: 11/01/2022] Open
Abstract
Resumo
Objetivo A capacidade de acesso anterior à região cervicotorácica com base na idade e gênero do paciente e a possibilidade de variações anatômicas em diferentes populações geográficas ainda não foram investigadas. O objetivo deste trabalho foi realizar uma análise radiográfica de pacientes brasileiros para avaliar a acessibilidade anterior da junção cervicotorácica conforme idade e gênero.
Métodos Análise radiográfica retrospectiva de 300 tomografias computadorizadas. Os pacientes foram separados por idade e gênero. Os parâmetros radiográficos estudados foram: nível horizontal acima do esterno (HLS, na sigla em inglês), angulação do corpo vertebral (VBA, na sigla em inglês), linha do disco intervertebral (IDL, na sigla em inglês) e angulação da linha do disco intervertebral (IDLA, na sigla em inglês).
Resultados Os HLS e IDL mais frequentes foram T2 (34,3%) e C7–T1 (46%), respectivamente. Os valores médios de VBA e IDLA foram de 18 ± 8,94 e 19 ± 7,9 graus, respectivamente. Os homens apresentaram valores maiores de IDLA (p = 0,003) e VBA (p = 0,02). Os grupos de maior idade apresentaram valores maiores de IDLA (p = 0,01) e VBA (p = 0,001). Não houve diferenças de HLS entre os gêneros masculino e feminino (p = 0,3) ou faixas etárias (p = 0,79). Não foram observadas diferenças na IDL entre os gêneros masculino e feminino (p = 0,3); entretanto, o grupo mais velho apresentou nível mais caudal do que os grupos mais jovens (p = 0,12).
Conclusões Em comparação a outras populações, nossa amostra apresentou IDL e HLS mais cefálicos. AVBA e a IDLA foram maiores no gênero masculino, enquanto VBA e IDLA foram maiores em grupos mais velhos. A IDL era mais caudal em pacientes idosos.
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Affiliation(s)
- Rafael Lindi Sugino
- Divisão de Cirurgia de Coluna, Instituto Vita, São Paulo, SP, Brasil
- Divisão de Cirurgia de Coluna, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Alexandre Sadao Iutaka
- Divisão de Cirurgia de Coluna, Instituto Vita, São Paulo, SP, Brasil
- Divisão de Cirurgia de Coluna, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Samuel K. Cho
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, Nova York, NY, Estados Unidos
| | - Daniel R. Cataldo
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, Nova York, NY, Estados Unidos
| | - Luis Marchi
- Divisão de Cirurgia de Coluna, Instituto Vita, São Paulo, SP, Brasil
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Sahasrabudhe PB, Pradhan MD, Panse N, Jagtap R. Post-CABG Deep Sternal Wound Infection: A Retrospective Comparative Analysis of Early versus Late Referral to a Plastic Surgery Unit in a Tertiary Care Center. Indian J Plast Surg 2021; 54:157-162. [PMID: 34239237 PMCID: PMC8257308 DOI: 10.1055/s-0041-1731256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background
Deep sternal wound infections (DSWI) following median sternotomy are initially treated by the cardiothoracic surgeons and are referred to a plastic surgical unit late in the course of time.
Methods
This is a retrospective review done in a tertiary care teaching institute from January 2005 to June 2018 and the data of 72 patients who had DSWI out of 4,214 patients who underwent median sternotomy for coronary artery bypass grafting (CABG) was collected with respect to the duration between CABG and presentation of DSWI as well as time of referral to a plastic surgery unit. We defined early referral as < or equal to 15 days from presentation and late referral as > 15 days. Both groups were compared with respect to multiple parameters as well as early and late postoperative course, postoperative complications, and mortality.
Results
The early group had 33 patients, while the late group had 39 patients. The number of procedures done by the cardiothoracic team before referral to the plastic surgery unit is significant (
p
= 0.002). The average duration from the presentation of DSWI to definitive surgery was found to be 16.58 days in the early group and 89.36 days in the late group. The rest of the variables that were compared in both the groups did not have significant differences.
Conclusion
There is no statistical difference between early and late referral to plastic surgery in terms of mortality and morbidity. Yet, early referrals could lead to highly significant reduction in total duration of hospital stay, wound healing, and costs. Early referral of post-CABG DSWIs to Plastic surgeons by the cardiothoracic surgeons is highly recommended.
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Affiliation(s)
- Parag B Sahasrabudhe
- Department of Plastic Surgery, Deenanath Mangeshkar Hospital & Research Centre, Pune, Maharashtra, India.,Department of Plastic Surgery, B.J. Medical Govt. College & Sassoon Hospitals, Pune, Maharashtra, India
| | - Mugdha D Pradhan
- Department of Plastic Surgery, Deenanath Mangeshkar Hospital & Research Centre, Pune, Maharashtra, India
| | - Nikhil Panse
- Department of Plastic Surgery, B.J. Medical Govt. College & Sassoon Hospitals, Pune, Maharashtra, India
| | - Ranjit Jagtap
- Department of Cardiothoracic Surgery, Deenanath Mangeshkar Hospital & Research Centre, Maharashtra, India
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Seyrek Y, Akkuş M. What is the impact of a previously failed Robicsek repair in the subsequent treatment of sternal dehiscence with thermoreactive nitinol clips? J Card Surg 2021; 36:3232-3239. [PMID: 34137076 DOI: 10.1111/jocs.15743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND In this study, we conducted a retrospective review of patients at our institution with noninfectious sternal dehiscence (NISD) after median sternotomy who received thermoreactive nitinol clips (TRNC) treatment during a 10-year period. The purpose of the study was to analyze the impact of previous Robicsek repair on the later treatment of sternal dehiscence with TRCN to establish which method was better in high-risk patients with NISD. METHODS Between December 2009 and January 2020, out of 283 patients with NISD who underwent refixation, we studied 34 cases who received TRNC treatment. We divided these 34 cases into two groups: patients who had a previously failed Robicsek procedure before TRNC treatment (group A, n = 11) and patients who had been directly referred to TRCN treatment (group B, n = 23). High-risk patients were defined as those having three or more risk factors. RESULTS Postoperative complication rate was significantly higher in group A (p = .026). Hospitalization duration was significantly longer in group A due to the higher complication rate (p = .001). Operative time was significantly shorter and blood loss was significantly lower in group B (p = .001). CONCLUSION The Robicsek procedure is considered an effective method in the treatment of NISD but, in case of its failure, subsequent TRNC treatment might become cumbersome in high-risk patients. In our study, a previously failed Robicsek procedure caused significantly higher morbidity, additional operative risk and lower success rate in later TRNC treatment of high-risk cases. Ultimately, we speculate that a direct TRNC treatment for NISD is favorable in high-risk patients.
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Affiliation(s)
- Yunus Seyrek
- Department of Thoracic Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Murat Akkuş
- Department of Thoracic Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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7
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Li Y, Wang S, Tai J, Zeng Q, Zhang J, Liu Y, Ge W, Huang Y, Zhang X, Liu Q, Sun N, Chen C, Ni X. Surgical Treatment of Cervicothoracic Junction Lesions in Children: A Series of 18 Cases. J INVEST SURG 2020; 35:263-267. [PMID: 33283571 DOI: 10.1080/08941939.2020.1839821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE The cervicothoracic junction (CTJ) lesions in children is rare. Surgical treatment for lesions at the cervicothoracic junction is challenging due to the presence of the great vessels and other thoracic structures. There are no criteria that help select a surgical approach to manage cervicothoracic lesions in children so far. This study focuses on the cervicothoracic junction lesions in children(C7-T4) and provides experience for the appropriate surgical approach for them. METHODS This retrospective study enrolled 18 children with cervicothoracic junction lesions who underwent surgical treatment in our Hospital from January 2015 to September 2019. They were evaluated with preoperative CT or MR imaging and diagnosed postoperatively by pathological examination. RESULTS This study included 2 patients with congenital lesions, 4 patients with benign lesions, and 12 patients with malignant lesions. Lesions with a margin below C7-T3, including benign and malignant tumors could be resected using a simple low anterior cervical approach (LACA). Congenital lesions and benign lesions with a margin below T4 could also be treated with this approach. Two-thirds of the malignant lesions below T4 were resected through the LACA combined with video-assisted thoracoscopic surgery (VATS). 1 patient with malignant lesion extending to T4 was removed by the LACA combined with posterolateral thoracotomy. CONCLUSIONS The lesions at the cervicothoracic junction (C7-T4) in children may be managed with the simple LACA used in most patients. For malignancies extending to the T4 level, LACA and VATS could be performed in combination to resect lesions completely and invasively.
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Affiliation(s)
- Yanzhen Li
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, P.R. China
| | - Shengcai Wang
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, P.R. China
| | - Jun Tai
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, P.R. China
| | - Qi Zeng
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical, University, National Center for Children's Health, Beijing, P.R. China
| | - Jie Zhang
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, P.R. China
| | - Yuanhu Liu
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, P.R. China
| | - Wentong Ge
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, P.R. China
| | - Yuzhang Huang
- Department of Health Policy Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Xuexi Zhang
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, P.R. China
| | - Qiaoyin Liu
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, P.R. China
| | - Nian Sun
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, P.R. China
| | - Chenghao Chen
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical, University, National Center for Children's Health, Beijing, P.R. China
| | - Xin Ni
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, P.R. China
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Diwan TS, Lee TC, Nagai S, Benedetti E, Posselt A, Bumgardner G, Noria S, Whitson BA, Ratner L, Mason D, Friedman J, Woodside KJ, Heimbach J. Obesity, transplantation, and bariatric surgery: An evolving solution for a growing epidemic. Am J Transplant 2020; 20:2143-2155. [PMID: 31965711 DOI: 10.1111/ajt.15784] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 01/05/2020] [Accepted: 01/08/2020] [Indexed: 01/25/2023]
Abstract
The increasing obesity epidemic has major implications in the realm of transplantation. Patients with obesity face barriers in access to transplant and unique challenges in perioperative and postoperative outcomes. Because of comorbidities associated with obesity, along with the underlying end-stage organ disease leading to transplant candidacy, these patients may not even be referred for transplant evaluation, much less be waitlisted or actually undergo transplant. However, the use of bariatric surgery in this population can help optimize the transplant candidacy of patients with obesity and end-stage organ disease and improve perioperative and postoperative outcomes. We review the impact of obesity on kidney, liver, and cardiothoracic transplant candidates and recipients and explore potential interventions to address obesity in these populations.
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Affiliation(s)
| | | | | | | | - Andrew Posselt
- University of California at San Francisco, San Francisco, California, USA
| | | | | | | | - Lloyd Ratner
- Columbia University Medical Center, New York, New York, USA
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Lo Torto F, Turriziani G, Donato C, Marcasciano M, Redi U, Greco M, Miraldi F, Ribuffo D. Deep sternal wound infection following cardiac surgery: A comparison of the monolateral with the bilateral pectoralis major flaps. Int Wound J 2020; 17:683-691. [PMID: 32065728 DOI: 10.1111/iwj.13324] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 01/28/2020] [Accepted: 02/02/2020] [Indexed: 01/28/2023] Open
Abstract
Deep sternal wound infections are a serious complication following sternotomy for cardiothoracic surgery. "Conventional" treatment provides debridement and secondary closure or closed catheter irrigation. The combination of the Negative Pressure Therapy with flap coverages is an accepted technique and one or both Pectoralis Major muscles could be chosen. A multistep protocol was adopted. One hundred and sixty seven patients were treated with the combination of Negative Pressure Therapy with the Pectoralis Major muscle flap: 86 monolateral flap and 81 bilateral flap reconstruction. The main complications (hematoma, seroma, dehiscence, and re-infection), the need for re-intervention, mortality rates, Intensive Care Unit, and hospitalisation time were assessed. The mono-pectoralis group had fewer complications and need for revision, with a shorter hospital stay. A statistically significant difference emerged for the hematoma rate (P = .0079). Monolateral flap should to be preferred because with the same coverage effectiveness, it guarantees the saving of controlateral muscle with its functionality and the possibility of its use in case of failure. Furthermore, as the technique is less invasive, it can be reserved for more fragile patients.
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Affiliation(s)
- Federico Lo Torto
- Department of Plastic Reconstructive and Aesthetic Surgery, Sapienza Università di Roma, Rome, Italy
| | - Gianmarco Turriziani
- Department of Plastic Reconstructive and Aesthetic Surgery, Sapienza Università di Roma, Rome, Italy
| | - Casella Donato
- Department of Breast Cancer Surgery, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Marco Marcasciano
- Department of Plastic Reconstructive and Aesthetic Surgery, Sapienza Università di Roma, Rome, Italy
| | - Ugo Redi
- Department of Plastic Reconstructive and Aesthetic Surgery, Sapienza Università di Roma, Rome, Italy
| | - Manfredi Greco
- Università degli studi "Magna Graecia" di Catanzaro, Catanzaro, Italy
| | - Fabio Miraldi
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza Università di Roma, Rome, Italy
| | - Diego Ribuffo
- Department of Plastic Reconstructive and Aesthetic Surgery, Sapienza Università di Roma, Rome, Italy
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Sternotomi fiksasyon metodlarının karşılaştırılması: Sert-rijit fiksasyona karşı aşırı kuvvet karşısında esnekliği ayarlanabilen yarı-esnek fiksasyon: Deneysel biyomekanik çalışma. JOURNAL OF CONTEMPORARY MEDICINE 2019. [DOI: 10.16899/jcm.609633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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11
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Closure of the sternum with anchoring of the steel wires: Systematic review and meta-analysis. J Thorac Cardiovasc Surg 2018; 156:178-186. [DOI: 10.1016/j.jtcvs.2018.02.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/30/2018] [Accepted: 02/11/2018] [Indexed: 11/20/2022]
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Rashed A, Gombocz K, Alotti N, Verzar Z. Is sternal rewiring mandatory in surgical treatment of deep sternal wound infections? J Thorac Dis 2018; 10:2412-2419. [PMID: 29850147 DOI: 10.21037/jtd.2018.03.166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Deep sternal wound infections (DSWIs) are a rare but serious complication after median sternotomy, and treatment success depends mainly on surgical experience. We compared treatment outcomes after conventional sternal rewiring and reconstruction with no sternal rewiring in patients with a sternal wound infection. Methods We retrospectively enrolled patients who developed a DSWI after an open-heart procedure with median sternotomy at the Department of Cardiac Surgery, at the St. Rafael Hospital, Zalaegerszeg, Hungary, between 2012 and 2016. All patients received negative pressure wound and antibiotic therapy before surgical reconstruction. Patients were divided into groups determined by the reconstruction technique and compared. Subjects were followed up for 12 months, and the primary end-points were readmission and 90-day mortality. Results Among 3,177 median sternotomy cases, 60 patients developed a DSWI, 4 of whom died of sepsis before surgical treatment. Fifty-six patients underwent surgical reconstruction with conventional sternal rewiring (23 cases, 41%) or another interventions with no sternal refixation (33 cases, 59%). Eighty-one percent of sternal wound infections followed coronary bypass surgery (alone or combinated with another procedures), and 60% were diagnosed after hospital discharge. Staphylococcus aureus was cultured in 30% of all wounds and, 56.5% of cases reconstructed by sternal rewiring vs. 26.5% with no sternal rewiring, (P=0.022). Hospital readmission occurred in 63.6% of the sternal rewiring group vs. 14.7% of the no sternal rewiring group. The rate of death before wound healing or the 90th postoperative day was 21.7% in the sternal rewiring group vs. 0% in the no sternal rewiring group. The median hospital stay was longer in the sternal rewiring group than in the other group (51 vs. 30 days, P=0.006). Conclusions Sternal rewiring may be associated with a higher rate of treatment failure than other forms of treatment for sternal wound infections.
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Affiliation(s)
- Aref Rashed
- Department of Cardiac Surgery, St. Rafael Zala County Hospital, Zalaegerszeg, Hungary
| | - Karoly Gombocz
- Department of Cardiac Surgery, St. Rafael Zala County Hospital, Zalaegerszeg, Hungary
| | - Nasri Alotti
- Department of Cardiac Surgery, St. Rafael Zala County Hospital, Zalaegerszeg, Hungary
| | - Zsofia Verzar
- Department of Emergency Medicine, Pecs University of Science, Pecs, Hungary
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Cottone G, Amendola F, Caminiti R, Magenes VC, Paderi M, Baruffaldi Preis FW. Breast Cerclage: An Innovative Expedient for Perimammary Dehiscence Healing. J Am Coll Clin Wound Spec 2018; 9:10-13. [PMID: 30591895 DOI: 10.1016/j.jccw.2018.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The perimammary zone is a critical area for healing, due to high incidence of dehiscences, expecially sternal ones. Although deep sternal wound complications are nowadays less common after cardiac surgery, in some at risk patients, dehiscences still represent important complications of major cardiac or vascular surgeries and they are directly correlated to an increased risk of patient's morbidity and mortality. A heavy breast represents a source of tension on the perimammary wound, inhibiting or delaying a complete recovery. We report the case of a 66-year-old female patient with a critical post-surgical sternal dehiscence and multiple chronic comorbidities. The dehiscence was managed with a routinely performed primary intention closure combined with an innovative breast cerclage. To our opinion, this is the first reported description of a breast cerclage used as an expedient to reduce tension on the wound and minimize the risk of relapse, allowing a rapid and complete healing. This novel technique has proved to be effective and satisfactory in the achievement of both a functional and aesthetic results and we are confident that it could become a fully-fledged wound healing issue in chest wall reconstruction.
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Affiliation(s)
- Giuseppe Cottone
- IRCCS Istituto Ortopedico Galeazzi - Università degli Studi di Milano, Plastic Surgery Department, Via Galeazzi 4, 20161 Milan, Italy.,Ospedale San Raffaele, Via Olgettina Milano, 60, 20132 Milano MI, Italy
| | - Francesco Amendola
- IRCCS Istituto Ortopedico Galeazzi - Università degli Studi di Milano, Plastic Surgery Department, Via Galeazzi 4, 20161 Milan, Italy.,Ospedale San Raffaele, Via Olgettina Milano, 60, 20132 Milano MI, Italy
| | - Rocco Caminiti
- IRCCS Istituto Ortopedico Galeazzi - Università degli Studi di Milano, Plastic Surgery Department, Via Galeazzi 4, 20161 Milan, Italy.,Ospedale San Raffaele, Via Olgettina Milano, 60, 20132 Milano MI, Italy
| | - Vittoria Carlotta Magenes
- IRCCS Istituto Ortopedico Galeazzi - Università degli Studi di Milano, Plastic Surgery Department, Via Galeazzi 4, 20161 Milan, Italy.,Ospedale San Raffaele, Via Olgettina Milano, 60, 20132 Milano MI, Italy
| | - Marta Paderi
- IRCCS Istituto Ortopedico Galeazzi - Università degli Studi di Milano, Plastic Surgery Department, Via Galeazzi 4, 20161 Milan, Italy.,Ospedale San Raffaele, Via Olgettina Milano, 60, 20132 Milano MI, Italy
| | - Franz Wilhelm Baruffaldi Preis
- IRCCS Istituto Ortopedico Galeazzi - Università degli Studi di Milano, Plastic Surgery Department, Via Galeazzi 4, 20161 Milan, Italy.,Ospedale San Raffaele, Via Olgettina Milano, 60, 20132 Milano MI, Italy
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Hendam H, El-Samouly H, Behairy HM, Noaman M, Abd Elshafy G. Mini Thoracotomy Approach to Upper Thoracic Spine. NEUROSCIENCE AND MEDICINE 2018; 09:9-15. [DOI: 10.4236/nm.2018.91002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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15
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Pinotti KF, El Dib R, Cataneo DC, Rodrigues OR, Silva LRE, Cataneo AJM. Sternal fixation techniques following sternotomy for preventing sternal wound complications. Hippokratia 2017. [DOI: 10.1002/14651858.cd010999.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Karin F Pinotti
- Universidade Estadual Paulista (UNESP); Department of Surgery; São Paulo Brazil
| | - Regina El Dib
- Institute of Science and Technology, Unesp - Univ Estadual Paulista; Department of Biosciences and Oral Diagnosis; Botucatu Brazil
| | - Daniele C Cataneo
- São Paulo State University; Department of Surgery & Orthopedics; Distrito de Rubião Júnior, s/n São Paulo Brazil 18618-970
| | | | - Leandro RE Silva
- Botucatu Medical School, UNESP - Univ Estadual Paulista; São Paulo Brazil
| | - Antonio José Maria Cataneo
- São Paulo State University; Department of Surgery & Orthopedics; Distrito de Rubião Júnior, s/n São Paulo Brazil 18618-970
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Pechetov AA, Esakov YS, Makov MA, Okonskaya DE, Basylyuk AV, Khlan TN. [Laparoscopic-assisted harvesting of omental flap in chest wall reconstruction for deep sternal wound infection]. Khirurgiia (Mosk) 2017:18-23. [PMID: 28805774 DOI: 10.17116/hirurgia2017818-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM To present an experience of laparoscopic-assisted harvesting of omental flap in chest wall reconstruction for deep sternal wound infection. MATERIAL AND METHODS It was made a prospective analysis of 14 patients aged 39-85 years after laparoscopic-assisted harvesting of omental flap in chest wall reconstruction for the period December 2014 - November 2016. Men/women ratio was 10/4. All patients had deep sternal wound infection grade IV (Oakley-Wright classification). RESULTS Postoperative complications were observed in 2 (14.3%) of 14 (95% CI: 4.0-39.9%) cases that did not require re-operation. There were no 30-day postoperative mortality and significant complications as acute intestinal obstruction, postoperative ventral herniation and transplant rejection. Mean postoperative hospital-stay was 10.5 (9; 13) days. CONCLUSION Laparoscopic-assisted harvesting of omental flap is safe method for chest wall reconstruction in patients with severe sternal wound infection associated with soft tissue deficiency and high risk of local complications (bleeding, etc.). Laparoscopy significantly reduces incidence of postoperative complications after omental flap transposition and is feasible in majority of patients.
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Affiliation(s)
- A A Pechetov
- A.V. Vishnevsky Surgery Institute of Health Ministry of the Russian Federation, Moscow, Russia
| | - Yu S Esakov
- A.V. Vishnevsky Surgery Institute of Health Ministry of the Russian Federation, Moscow, Russia
| | - M A Makov
- A.V. Vishnevsky Surgery Institute of Health Ministry of the Russian Federation, Moscow, Russia
| | - D E Okonskaya
- A.V. Vishnevsky Surgery Institute of Health Ministry of the Russian Federation, Moscow, Russia
| | - A V Basylyuk
- A.V. Vishnevsky Surgery Institute of Health Ministry of the Russian Federation, Moscow, Russia
| | - T N Khlan
- A.V. Vishnevsky Surgery Institute of Health Ministry of the Russian Federation, Moscow, Russia
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Median poststernotomy dehiscence reconstruction—a new classification for selection of the best procedure. EUROPEAN JOURNAL OF PLASTIC SURGERY 2016. [DOI: 10.1007/s00238-016-1210-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The Impact of Deep Sternal Wound Infection on Mortality and Resource Utilization: A Population-based Study. World J Surg 2016; 40:2673-2680. [DOI: 10.1007/s00268-016-3598-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sahasrabudhe P, Jagtap R, Jadhav A, Panse N, Juvekar N, Patwardhan S. Audit of 37 cases of deep sternal wound infections (DSWIs) following 2418 coronary artery bypass graftings (CABGs). Indian J Thorac Cardiovasc Surg 2016. [DOI: 10.1007/s12055-016-0425-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Zhang Y, Li JZ, Hao YJ, Lu XC, Shi HL, Liu Y, Zhang PF. Sternal tumor resection and reconstruction with titanium mesh: a preliminary study. Orthop Surg 2016; 7:155-60. [PMID: 26033997 DOI: 10.1111/os.12169] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/16/2015] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To explore the clinical efficacy and complications of treating sternal tumors by resection and titanium mesh thoracic reconstruction. METHODS This retrospective analysis of eight patients with sternal tumors treated in the Department of Orthopedic Surgery at the First Affiliated Hospital of Zhengzhou University from January 2008 to June 2012 included five men and three women aged 37-66 years (mean, 50.4 years). The histological diagnoses were chondrosarcoma (two cases), osteosarcoma (one), malignant fibrous histiocytoma (two), eosinophilic granuloma (one) and sternal metastasis from breast cancer (two). The tumors were invading the manubrium sterni (three cases), manubrium sterni and body (three) and sternal body (two). All patients underwent needle or incisional biopsy prior to sternal tumor resection and titanium mesh thoracic reconstruction. RESULTS All patients were followed for 9 months to 4 years. There were no intraoperative complications or operative or postoperative deaths. One patient developed a deep wound hematoma 1 week postoperatively; incisional drainage and debridement resulting in healing within 2 weeks. There was no loosening or exsertion of the titanium mesh and no patients developed respiratory complications or thoracic deformity. One patient with malignant fibrous histiocytoma died of lung metastases 9 months postoperatively, another with malignant fibrous histiocytoma died of liver metastases 14 months postoperatively; the remaining patients survived without tumor recurrence. CONCLUSION Titanium mesh chest reconstruction after sternal tumor resection has the advantages of simplifying the procedure, achieving a good shape and having few complications. Titanium mesh is an ideal material for reconstruction of the sternum.
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Affiliation(s)
- Yan Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jia-zhen Li
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying-jie Hao
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin-chang Lu
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hai-long Shi
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuan Liu
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peng-fei Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Accessibility of the Cervicothoracic Junction Through an Anterior Approach: An MRI-based Algorithm. Spine (Phila Pa 1976) 2016; 41:69-73. [PMID: 26335674 DOI: 10.1097/brs.0000000000001155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional observational study. OBJECTIVE To formulate a reliable method and modality for preoperative planning and to determine the effects of height, body mass index (BMI), and age on accessibility to the upper thoracic vertebrae through an anterior cervical approach. SUMMARY OF BACKGROUND DATA Various modalities have been proposed to determine the lowest spinal-level accessible through a traditional anterolateral cervical approach and the consequent need for manubriotomy. Past methods have routinely involved a variety of imaging studies such as plain radiographs and computed tomography but the reliability of these methods has not been assessed. METHODS The Magnetic Resonance Imaging (MRI) images of 180 patients classified by age and gender were evaluated and the most caudal accessible intervertebral disc space was determined from an approach angle beginning at the suprasternal notch. Plain cervical radiographs were also reviewed when available. In patients with multiple imaging studies, the reliability of the measurements was compared. Rate of accessibility was compared across different heights, BMIs, and ages. RESULTS A novel algorithm that utilized both the scout and mid-sagittal T2 MRIs was able to determine the most caudal cervicothoracic level accessible for anterior access in 93.3% of patients with a reliability of 96.8%. Conversely, plain radiograph evaluation led to low reliability (66.7%) and low agreement with MRI (60%) with an average error of one spinal level. In this patient sample, the T1 to T2 disc space was accessible in 82.7% of patients. Age and BMI were independent variables associated with accessibility (p < 0.01) while height was determined not to be significant (p = 0.09). CONCLUSION Data in this study suggest an MRI-based algorithm with a combination of scout and sagittal T2 images offers a reliable and consistent assessment of accessibility to upper thoracic levels through an anterior approach. Age and body mass index are major determinants of accessibility.
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Zhao Y, Peng C, Liu Y, Hao Y, Zhao X, Chong B. Clinical Study of Allogeneic Graft Reconstruction for Sternum Tumor. EXP CLIN TRANSPLANT 2015. [PMID: 26222915 DOI: 10.6002/ect.2014.0119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES This paper aimed to study the feasibility, the surgical methodology, and technique for reconstruction using allogeneic sternal graft after sternum tumor resection. MATERIALS AND METHODS Three patients (2 men and 1 woman, aged 19, 44, and 52) with primary sternum malignant tumor were admitted from January 2008 to December 2010 to the Second Hospital of Shandong University, Jinan, China. We conducted subtotal resection of the sternum and simultaneous reconstruction with allogeneic sternal graft. Allogeneic sternum was frozen beforehand; the scope of removal was 2 cm away from the lesion. Transplanted allogeneic sternum was fixed using steel wire and residual cavity was filled with the greater omentum. RESULTS Three patients recovered without major complication and were discharged from the hospital with successful operation and satisfactory results. They were followed-up for 6 months to 2 years, no tumor relapse or any obvious rejection were found. CONCLUSIONS The freezing allogeneic sternum can be used as a substitute for reconstruction after sternum tumor resection.
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Affiliation(s)
- Yunpeng Zhao
- From the Thoracic Department, the Second Hospital of Shandog?University, 247, Beiyuan Street, Jinan, China
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Doherty C, Nickerson D, Southern DA, Kieser T, Appoo J, Dawes J, De Souza MA, Harrop AR, Rabi D. Trends in postcoronary artery bypass graft sternal wound dehiscence in a provincial population. Plast Surg (Oakv) 2014. [DOI: 10.1177/229255031402200311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | - Danielle A Southern
- Department of Community Health Sciences; Calgary, Alberta
- Institute for Public Health, University of Calgary; Calgary, Alberta
| | - Teresa Kieser
- Libin Cardiovascular Institute of Alberta; Calgary, Alberta
- Division of Cardiac Surgery, Department of Surgery; Calgary, Alberta
| | - Jehangir Appoo
- Libin Cardiovascular Institute of Alberta; Calgary, Alberta
- Division of Cardiac Surgery, Department of Surgery; Calgary, Alberta
| | | | | | | | - Doreen Rabi
- Department of Community Health Sciences; Calgary, Alberta
- Institute for Public Health, University of Calgary; Calgary, Alberta
- Department of Medicine, University of Calgary, Calgary, Alberta
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Mini-open anterior approach to the cervicothoracic junction: a cadaveric study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:1533-8. [PMID: 23563573 DOI: 10.1007/s00586-013-2766-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 03/04/2013] [Accepted: 03/30/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE To investigate the feasibility of mini-open anterior approach to the cervicothoracic junction (CTJ) in cadaveric specimens. METHODS Four adult fresh-frozen cadaveric specimens were used for this study. On the cadaveric specimen, an osteotomy window was made in manubrium sterni to remove the bony obstacle. To bypass the vital vascular and neural structures over the operative field, we used the surgical corridor which was located medially by the brachiocephalic artery and laterally by the right brachiocephalic vein, or in combination with another surgical corridor between the ascending aorta and the superior vena cava. And we used a special self-retaining retractor system and an endoscope to facilitate the procedures. RESULTS Surgical procedures performed on the four fresh-frozen cadaveric specimens to expose the CTJ through mini-open anterior approach were successful. The anterior surface of C6-T5 could be exposed, allowing complete decompression and application of locking plate and screws. The most caudal accessible vertebral body was T5 vertebral body in our study. CONCLUSION It is feasible to expose the CTJ through this mini-open anterior approach.
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Sahasrabudhe P, Jagtap R, Waykole P, Panse N, Bhargava P, Patwardhan S. Our experience with pectoralis major flap for management of sternal dehiscence: A review of 25 cases. Indian J Plast Surg 2012; 44:405-13. [PMID: 22279272 PMCID: PMC3263267 DOI: 10.4103/0970-0358.90810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To report our experience of the pectoralis major flap as the treatment modality for post coronary artery bypass sternal wound dehiscence. Materials and Methods: A retrospective study of 25 open heart surgery cases, performed between January 2006 and December 2010 at Deenanath Mangeshkar Hospital, Pune, was carried out. Unilateral or bilateral pectoralis major muscle flap by the double breasting technique using rectus extension was used in the management of these patients. The outcome was assessed on the basis of efficacy of flap surgery in achieving wound healing and post-surgery shoulder joint movements to evaluate donor site morbidity. The follow-up ranged from 5 months to 3.5 years. Results: Twenty-three (92%) patients were discharged with complete wound closure. One patient (4%) had wound dehiscence after flap surgery. One patient (4%) died in the hospital in the immediate postoperative period due to mediastinitis. No recurrent sternum infection has occurred till date in 24 patients (96%). For one patient (4%) who had wound dehiscence, daily dressing was done and wound healing was achieved with secondary intension. At follow-up, shoulder joint movements were normal in all the patients. Conclusions: The double breasting technique of the pectoralis major muscle flaps with rectus sheath extension is efficient in covering the entire length of the defect and can reduce the morbidity, without affecting the function of the shoulder joint.
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Affiliation(s)
- Parag Sahasrabudhe
- Department of Plastic and Cosmetic Surgery, Deenanath Mangeshkar Hospital, B. J. Medical College and Sassoon Hospitals, Pune, India
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Lam FC, Groff MW. An anterior approach to spinal pathology of the upper thoracic spine through a partial manubriotomy. J Neurosurg Spine 2011; 15:467-71. [PMID: 21780863 DOI: 10.3171/2011.6.spine11189] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Surgical pathology in the region of the upper thoracic spine (T1-4) is uncommon compared with other regions of the spine. Often times posterior and posterolateral approaches can be used, but formal anterior decompression often requires a low anterior cervical approach combined with a sternotomy, which yields significant perioperative morbidity. The authors describe a modified low anterior cervical dissection combined with a partial manubriotomy that they have used to successfully access and decompress anterior pathology of the upper thoracic spine. Their modified approach spares the sternoclavicular joints and leaves the sternum intact, decreasing the morbidity associated with these added procedures.
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Affiliation(s)
- Fred C Lam
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA
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The septum-based therapeutic mammaplasty technique for management of sternal defects. Plast Reconstr Surg 2010; 125:569-573. [PMID: 20124842 DOI: 10.1097/prs.0b013e3181c82e54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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