Domene C E, Volpe P, Onari P, Szachnowicz S, Birbojm I, Barreira L F, Reiff A M, Pinotti H W
Department of Gastroenterology, University of Sao Paulo Medical School Clinics Hospital, Brazil.
Surg Laparosc Endosc. 1998 Jun;8(3):215-8.
The reconstruction of complex defects of the chest wall after infection of the sternotomy wound presents a great challenge. Various options have been described for these reconstructions using muscle and omental flaps to fill the space and cover the defect. A case of reconstruction of a large defect of the chest cage and abdominal wall in a 62-year-old patient is presented. After surgery for revascularization of the myocardium, the patient developed mediastinitis, osteomyelitis, and necrosis of the sternum. The pectoralis major muscle was utilized for the reconstruction, but total loss of the flap occurred. After débridement, an omental flap obtained by laparoscopy was employed based on the left gastroepiploic artery. The omentum was transposed without complications through the abdominal wall defect. An overlay skin graft with the omentum as receptor bed completed the closure. There are advantages in using minimally invasive videolaparoscopy compared with laparotomy in obtaining the omentum, with the same result regarding reconstruction of the defect.
胸骨切开术后伤口感染后胸壁复杂缺损的重建是一项巨大挑战。对于这些重建，已经描述了使用肌肉和网膜瓣填充空间并覆盖缺损的各种方法。本文介绍了一名62岁患者胸壁和腹壁大缺损重建的病例。在进行心肌血运重建手术后，患者发生了纵隔炎、骨髓炎和胸骨坏死。使用胸大肌进行重建，但皮瓣完全坏死。清创后，采用基于左胃网膜动脉的腹腔镜获取的网膜瓣。网膜通过腹壁缺损无并发症地移位。以网膜为受体床的覆盖皮片完成了闭合。与开腹手术相比，使用微创电视腹腔镜获取网膜具有优势，在缺损重建方面结果相同。
