Department of Plastic and Reconstructive Surgery, Denver Health Medical Center, University of Colorado Health Sciences Center, 777 Bannock Street, Denver, 80204 Colorado USA.
World J Emerg Surg. 2010 May 7;5:12. doi: 10.1186/1749-7922-5-12.
An alcoholic 50-year-old male patient with a history of schizophrenia sustained stab wounds into both ventricles and left lung, and survived following an emergency department thoracotomy. The EDT wound, however became infected requiring serial debridements of soft tissue, rib cartilage and sternum. Regional flap options such as pectoralis major and latissimus dorsi muscle flaps could not be employed due to inadequate reach of these flaps. Additionally, bilateral transection of the internal mammary arteries during emergency thoracotomy eliminated the use of rectus abdominis muscles as pedicled flaps based on the superior epigastric vasculature. Therefore, the EDT wound was reconstructed by using the right rectus abdominis muscle as a free flap. The deep inferior epigastric vessels of the flap were anastomosed to the right internal mammary vessels proximal to their transection level in the third-forth intercostal space. The flap healed with no further wound complications.
一位 50 岁的酒精性男性精神分裂症患者，因刺伤导致左右心室和左肺受伤，在急诊科进行了开胸手术后幸存下来。然而，EDT 伤口感染，需要多次清创软组织、肋软骨和胸骨。由于这些皮瓣的可及性不足，无法使用胸大肌和背阔肌等区域性皮瓣。此外，由于在紧急开胸手术中双侧切断了内乳动脉，因此无法使用基于腹壁上血管的腹直肌作为带蒂皮瓣。因此，使用右腹直肌作为游离皮瓣来重建 EDT 伤口。皮瓣的深下腹壁血管与在第三至第四肋间水平切断的右内乳血管吻合。皮瓣愈合，没有进一步的伤口并发症。
