Brown Rodger H, Sharabi Safa E, Kania Katarzyna E, Hollier Larry H, Izaddoost Shayan A
Houston, Texas.
From the Division of Plastic and Reconstructive Surgery, Baylor College of Medicine.
Plast Reconstr Surg. 2017 Jun;139(6):1474-1477. doi: 10.1097/PRS.0000000000003328.
The pectoralis major is a versatile flap used as an advancement or turnover flap for sternal wound treatment. The advancement flap provides suboptimal inferior sternal coverage and poorly fills mediastinal dead space. The turnover flap covers the inferior sternum and fills dead space but requires disinsertion of the muscle from the humerus, resulting in functional loss and cosmetic deformity.
The authors describe a new technique of splitting the pectoralis muscle along its fibers, using the superior portion as an advancement flap and the inferior portion as a turnover flap.
Eleven patients underwent the described technique. Nine patients healed without complications or repeated operations. One patient had a recurrent aortic graft infection requiring reoperation. One patient had a postoperative seroma requiring incision and drainage.
Using the pectoralis as an advancement and turnover flap allows inferior sternum and mediastinum coverage using one donor site and maintaining the function of the muscle and preventing cosmetic deformity.
胸大肌是一种多功能皮瓣，用作推进皮瓣或翻转皮瓣来治疗胸骨伤口。推进皮瓣对胸骨下部的覆盖效果欠佳，且对纵隔死腔的填充效果不佳。翻转皮瓣可覆盖胸骨下部并填充死腔，但需要将肌肉从肱骨上离断，导致功能丧失和外观畸形。
作者描述了一种沿着胸大肌纤维将其劈开的新技术，用上半部分作为推进皮瓣，下半部分作为翻转皮瓣。
11例患者接受了所述技术。9例患者愈合良好，无并发症或再次手术。1例患者发生复发性主动脉移植物感染，需要再次手术。1例患者术后出现血清肿，需要切开引流。
将胸大肌用作推进皮瓣和翻转皮瓣，可利用一个供区覆盖胸骨下部和纵隔，同时保持肌肉功能并防止外观畸形。
