Archives of Plastic Surgery

  • 제32권4호
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  • Pages.421-427
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  • 2005
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  • 2234-6163(pISSN)
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  • 2234-6171(eISSN)
대한성형외과학회 (Korean Society of Plastic and Reconstructive Surgeons)
권호 표지

개흉술 후 발생한 종격동염의 대흉근-복직근 양경근피판을 이용한 치료

Pectoralis Major-Rectus Abdominis Bipedicle Muscle Flap in Treatment of Postoperative Mediastinitis

  • 김범진 (연세대학교 의과대학 인체조직복원연구소, 성형외과학교실) ;
  • 이원재 (연세대학교 의과대학 인체조직복원연구소, 성형외과학교실) ;
  • 탁관철 (연세대학교 의과대학 인체조직복원연구소, 성형외과학교실)
  • Kim, Bom Jin (Institution for Human Tissue Restoration, Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine) ;
  • Lee, Won Jai (Institution for Human Tissue Restoration, Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine) ;
  • Tark, Kwan Chul (Institution for Human Tissue Restoration, Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine)
  • 투고 : 2005.04.06
  • 발행 : 2005.07.10
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초록

Although the incidence of mediastinal wound infection in patient undergoing median sternotomy for cardiovascular surgery is relatively low(less than 1%), it is not only a devastating and potentially life-threatening complication but also associated morbidity, mortality and cost are unacceptably high. During the past few decades various methods had been applied for the treatment of postoperative mediastinitis. Currently, chest wall reconstruction by using muscle flaps-especially pectoralis major muscle and rectus abdominis muscle are commonly selected for the reconstruction after wide debridement has become widely accepted. We performed bilateral pectoralis major-rectus abdominis muscles in-continuity bipedicle flap to overcome the limit of each flap for reconstruction of sternal defects in 17 patients. We analyzed the results of the surgery. Recurrent infection developed in 17.6% of cases and abdominal herniation was observed in one patient. There was no postoperative hematoma or death. We conclude that this flap is very valuable in reconstruction of the anterior chest wall defect caused by post-sternotomy infection because it provides sufficient volume to fill the entire mediastinum, and the complication rate compares favorably to that of other methods.

키워드

과제정보

연구 과제 주관 기관 : 연세대학교

참고문헌

  1. El Oakley RM, Wright JE: Postoperative mediastinitis: classification and management. Ann Thorae Surg 61: 1030, 1996 https://doi.org/10.1016/0003-4975(95)01035-1
  2. Robicsek F: Postoperative sterno-mediastinitis. Am Surg 66: 184, 2000
  3. Shabat S, Gur E, Weiss J, Shafir R: Chest wall reconstruction for sternal wound infection after internal mammary and gastroepiploic coronary artery bypass. Plast Reeonstr Surg 102: 1771, 1998
  4. Jones G, Jurkiewicz MJ, Bostwick J, Wood R, Bried JT, Culbertson J, HoweH R, Eaves F, Carlson G, Nahai F: Management of the infected median sternotomy wound with muscle flaps. The Emory 20-year experience. Ann Surg 225: 766, 1997 https://doi.org/10.1097/00000658-199706000-00014
  5. Song DH, Wu LC, Lohman RF, Gottlieb LJ, Franczyk M: Vacuum assisted closure for the treatment of sternal wounds: the bridge between debridement and definitive closure. Plast Reconstr Surg 111: 92, 2003 https://doi.org/10.1097/01.PRS.0000056833.17907.01
  6. Ringelman PR, Vander Kolk CA, Cameron D, Baumgartner WA, Manson PN: Long-term results of flap reconstruction in median sternotomy wound infections. Plast Reconstr Surg 93: 1208, 1994 https://doi.org/10.1097/00006534-199405000-00015
  7. Netscher DT, Eladoumikdachi F, Goodman CM: Rectus abdominis muscle flaps used successfully for median sternotomy wounds after ipsilateral internal mammary artery ligation. Ann Plast Surg 47: 223, 2001 https://doi.org/10.1097/00000637-200109000-00001
  8. Weinzweig N, Yetman R: Transposition of the greater omentum for recalcitrant median sternotomy wound infections. Ann Plast Surg 34: 471, 1995 https://doi.org/10.1097/00000637-199505000-00004
  9. Aylor GI, Minabe T: The angiosomes of the mammals and other vertebrates. Plast Reeonstr Surg 89: 181, 1992 https://doi.org/10.1097/00006534-199202000-00001
  10. Russell RC, FeHer AM, Elliott LF, Kucan JO, Zook EG: The extended pectoralis major myocutaneous flap: uses and indications. Plast Reconstr Surg 88: 814, 1991 https://doi.org/10.1097/00006534-199111000-00012
  11. Solomon MP, Granick MS: Bipedicle muscle flaps in sternal wound repair. Plast Reeonstr Surg 101: 356, 1998 https://doi.org/10.1097/00006534-199802000-00013
  12. Jeevanandarn V, Smith CR, Rose EA, MaIm JR, Hugo NE: Single-stage management of sternal wound infections. J Thorae Cardiovase Surg 99: 256, 1990
  13. Brandt C, Alvarez JM: First-line treatment of deep sternal infection by a plastic surgical approach: superior results compared with conventional cardiac surgical orthodoxy. Plast Reeonstr Surg 109: 2231, 2002 https://doi.org/10.1097/00006534-200206000-00009
  14. Pairolero Pc, Arnold PG, Harris JB: Long-term results of pectoralis major muscle transposition for infected sternotomy wounds. Ann Surg 213: 583, 1991 https://doi.org/10.1097/00000658-199106000-00008
  15. Yoo YC, Chung SI, Yang WY, Park J: Treatment of acute sterno-mediastinitis using regional muscle flaps. J Korean Soc Plast Reeonstr Surg 30: 345, 2003