Myllykangas Heidi-Mari P, Mustonen Paula K, Halonen Jari K, Berg Leena T
a Department of Plastic Surgery , Kuopio University Hospital , Kuopio , Finland.
b Faculty of Health Sciences, University of Eastern Finland , Kuopio , Finland.
Scand Cardiovasc J. 2018 Oct;52(5):275-280. doi: 10.1080/14017431.2018.1546897. Epub 2019 Jan 4.
There are multiple treatment strategies and flap options to cover defects after deep sternal wound infections and other similar sternal defects. The choice of flap is made according to surgeons' preferences and the size and location of the defect. Our aim is to introduce a new option to cover these kinds of defects with an internal mammary artery perforator flap combined with a pectoralis major muscle flap mostly raised with a muscle-sparing technique.
We treated 13 patients with a sternal defect after cardiothoracic operations with this technique between 2010-2016. Ten patients had a deep sternal wound infection, two had an infection of the prosthesis after carotico-subclavian bypass and one had a fragmented sternum. Nine patients were treated with an internal mammary artery perforator fasciocutaneous flap with a muscle-sparing pectoralis major muscle flap and four patients with an internal mammary artery perforator fasciocutaneous flap combined with a right pectoralis major muscle flap.
Three patients (23%) experienced major complications and four patients (31%) had conservatively treated minor complications. There were no flap losses.
This combination of flaps is a suitable option for patients with large defects in whom direct skin closure is not possible. It can be utilized for defects comprising the entire vertical length of the sternum. These are local flaps with a short operation time and are therefore most suitable for patients with comorbidities in whom major surgery is not an option.
对于深部胸骨伤口感染及其他类似胸骨缺损后的缺损覆盖，有多种治疗策略和皮瓣选择。皮瓣的选择依据外科医生的偏好以及缺损的大小和位置而定。我们的目的是介绍一种新的选择，即采用胸廓内动脉穿支皮瓣联合胸大肌皮瓣（大多采用保留肌肉技术掀起）来覆盖这类缺损。
2010年至2016年间，我们采用该技术治疗了13例心胸手术后出现胸骨缺损的患者。10例患者患有深部胸骨伤口感染，2例在颈动脉 - 锁骨下动脉搭桥术后出现假体感染，1例胸骨碎裂。9例患者采用胸廓内动脉穿支筋膜皮瓣联合保留肌肉的胸大肌皮瓣治疗，4例患者采用胸廓内动脉穿支筋膜皮瓣联合右侧胸大肌皮瓣治疗。
3例患者（23%）出现严重并发症，4例患者（31%）有经保守治疗的轻微并发症。未出现皮瓣坏死。
这种皮瓣组合对于无法直接缝合皮肤的大缺损患者是一种合适的选择。它可用于包括胸骨整个垂直长度的缺损。这些是手术时间短的局部皮瓣，因此最适合不适合进行大手术的合并症患者。
