Department of Surgery, China Medical University Hospital, Taichung, Taiwan.
School of Medicine, China Medical University, Taichung, Taiwan.
Microsurgery. 2022 Nov;42(8):810-816. doi: 10.1002/micr.30949. Epub 2022 Aug 8.
The combined pedicled pectoralis major-latissimus dorsi (PM-LD) and free extended anterolateral thigh (ALT) myocutaneous flaps provide well-vascularized tissues for extensive sternal wound reconstruction. However, the outcomes and postoperative complications between the two surgical techniques are different. Thus, the aim of this study is to evaluate the feasibility of these two reconstructive options.
This single-center, retrospective study was conducted between August 2011 and May 2019. Forty-four patients diagnosed with deep sternal wound infection (DSWI) and presented with grade four complications (sternal instability and necrotic bone tissue) were enrolled. Two reconstructive strategies, namely, combined pedicled PM-LD (n = 24) and free extended ALT (n = 20) myocutaneous flaps, were used according to the patients' hemodynamics. Data including age, gender, body mass index (BMI), hospital stay, follow-up, defect/flap size, number of surgical procedures before reconstruction, duration from the last debridement to flap coverage, comorbidities, and postoperative complications, were obtained for statistical analysis.
The mean defect size in the combined PM-LD myocutaneous flap group was 188.4 (517-1023) cm , and the mean flap size was 150.0 (812-1515) cm and 205.0 (815-1025) cm in PM and LD flap, respectively. The mean defect size in the free extended ALT myocutaneus flap group was 202.5 (616-1021) cm , and the mean flap size was 285.2 (930-1225) cm . No significant differences were observed between the free extended ALT and the combined pedicled PM-LD myocutaneous flaps in relation to age, gender, BMI, hospital days, follow-up, defect size, preoperative procedures, and comorbidities, except for the average operative time (443.2 ± 31.2 vs. 321.3 ± 54.3 mins, p = .048). The combined pedicled PM-LD myocutaneous flap had significantly more donor site complications, including seroma (21% vs. 0%, p = .030), bilateral nipple-areolar complex asymmetry (100% vs. 0%, p < .0001), and skin graft loss with infection (33% vs. 0%; p = .044) than the free extended ALT myocutaneous flap.
The free extended ALT and the combined pedicled PM-LD myocutaneous flaps were both feasible and effective options for sternal wound reconstruction. Our findings suggested that the free extended ALT myocutaneous flap may be a better alternative for a comprehensive and extensive reconstruction of sternal wounds. Further studies based on these findings can be conducted.
带蒂胸大肌-背阔肌（PM-LD）联合游离延伸股前外侧肌（ALT）肌皮瓣为广泛的胸骨伤口重建提供了血供良好的组织。然而，两种手术技术的结果和术后并发症不同。因此，本研究旨在评估这两种重建选择的可行性。
这是一项单中心回顾性研究，于 2011 年 8 月至 2019 年 5 月进行。共纳入 44 例诊断为深部胸骨伤口感染（DSWI）并出现 4 级并发症（胸骨不稳定和坏死骨组织）的患者。根据患者的血液动力学情况，采用两种重建策略，即带蒂 PM-LD 联合（n=24）和游离延伸 ALT（n=20）肌皮瓣。收集年龄、性别、体重指数（BMI）、住院时间、随访、缺损/皮瓣大小、重建前手术次数、末次清创至皮瓣覆盖的时间、合并症和术后并发症等数据进行统计分析。
带蒂 PM-LD 肌皮瓣组的平均缺损大小为 188.4（517-1023）cm，PM 和 LD 皮瓣的平均皮瓣大小分别为 150.0（812-1515）cm 和 205.0（815-1025）cm。游离延伸 ALT 肌皮瓣组的平均缺损大小为 202.5（616-1021）cm，平均皮瓣大小为 285.2（930-1225）cm。游离延伸 ALT 与带蒂 PM-LD 肌皮瓣组在年龄、性别、BMI、住院天数、随访、缺损大小、术前手术次数和合并症方面无显著差异，除平均手术时间（443.2±31.2 vs. 321.3±54.3 分钟，p=0.048）外。带蒂 PM-LD 肌皮瓣的供区并发症明显多于游离延伸 ALT 肌皮瓣，包括血清肿（21% vs. 0%，p=0.030）、双侧乳头乳晕复合体不对称（100% vs. 0%，p<0.0001）和皮瓣感染性皮肤移植丢失（33% vs. 0%；p=0.044）。
游离延伸 ALT 和带蒂 PM-LD 肌皮瓣均是胸骨伤口重建的可行有效选择。我们的研究结果表明，游离延伸 ALT 肌皮瓣可能是胸骨伤口全面广泛重建的更好选择。可以基于这些发现进行进一步的研究。
