Açık Kalp Cerrahisi Sonrası Oluşan Göğüs Ön Duvarı Yumuşak Doku Defektlerinin Pektoral Kas Flebi ile Rekonstrüksiyonu

Amaç: Açık kalp cerrahisi sonrası görülen sternal yara enfeksiyonu ve buna bağlı gelişen yumuşak doku defekti morbitide ve mortaliteyi artıran ağır bir komplikasyondur. Bu makalede , açık kalp cerrahisi geçirmiş olan ve sonrasında mediyan sternal insizyon hattında gelişen enfeksiyon nedeni ile göğüs ön duvarında yumuşak doku defekti oluşan hastaların pektoralis majör kas flep ile rekonstrüksiyonu sunulmuş ve tecrübelerimiz aktarılmıştır. Gereç ve Yöntemler: 2012-2017 yılları arasında toplam 7 hastaya, açık kalp cerrahisi sonrası sternal insizyon hattında gelişen enfeksiyon sonrası oluşan göğüs ön duvarı yumuşak doku defektlerine pektoralis majör kas flebi ile rekonstrüksiyon uygulanmıştır.Bulgular: 1 hastada erken dönem hematom oluştu ve tekrar operasyona alındı. 1 hastada flep üzerine konulan deri greftinde kısmi kayıp oluştu ve tekrar uyluktan alınan kısmi kalınlıkta deri grefti ile defekt kapatıldı. Diğer hastalarda yara iyileşmesi problemi gözlenmedi ve tam iyileşme sağlandı. Sonuç: Sonuç olarak; açık kalp cerrahisi sonrası gelişen göğüs ön duvarı yumuşak doku defektlerinde, yeterli debridman ile birlikte pektoral kas flebi ile onarım uygun olgularda etkili ve güvenilir bir yöntemdir

Anahtar Kelimeler:

Göğüs ön duvarı defekti, Pektoralis majör kas flebi, Sternal yumuşak doku defekti

Reconstruction with Pectoralis Muscle Flap of Soft Tissue Defect of Anterior Chest Wall Following Open Heart Surgery

Objective: The sternal wound infection following open heart surgery and its associated soft tissue defect is a serious complication that increases morbidity and mortality. In this article, we describe the reconstruction with the pectoralis major muscle flap in patients who have undergone open heart surgery and later developed a soft tissue defect in the median sternal incision line with the cause of infection, and our experience is reported.Material and Methods: A total of 7 patient underwent reconstruction of soft tissue defects of the chest wall due to infection developed in the sternal incision following open heart surgery with pectoralis major muscle flap between 2012 and 2017.Results: Early postoperative hematoma occurred in one patient and reoperated. Partial loss occurred in the skin graft placed on the flap in 1 patient and the defect was closed with partial thickness skin graft taken from the thigh. In other patients, there was no wound healing problem and full recovery was achieved.Conclusion: As a result; reconstruction of anterior chest wall soft tissue defect following open heart surgery with pectoralis muscle flap and adequate debridement is an effective and reliable method

Keywords:

Anterior chest wall defect, Pectoralis major muscle flap, Sternal soft tissue defect,

PDF

___

1. Ridderstolpe L, Gill H, Granfeldt H, Ahlfeldt H, Rutberg H. Superficial and deep sternal wound complications: incidence, risk factors and mortality. Eur J Cardiothorac Surg 2001;20:1168-75.
2. Borger MA, Rao V, Weisel RD, Ivanov J, Cohen G, Scully HE, David TE. Deep sternal wound infection: Risk factors and outcomes. Ann Thorac Surg 1998;65: 1050–6.
3. Arnold PG, Pairolero PC. Chest wall reconstruction: An account of 500 consecutive patients. Plast Reconstr Surg1996;98:804-10.
4. Mansour KA, Thourani VH, Losken A, Reeves JG, Miller JI Jr, Carlson GW, Jones GE. Chest wall resections and reconstruction: A 25-year experience, Ann Thorac Surg 2002;73:1720-6.
5. Jones G, Jurkiewicz MJ, Bostwick J, Wood R, Bried JT, Culbertson J, Howel R, Eaves F, Carlson G, Nahai F. Management of the infected median sternotomy wound with muscle flaps: The Emory 20 year experience. Ann Surg 1997; 225: 766.
6. Pairolero PC, Arnold PG, Harris JB. Long-term results of pectoralis major muscle transposition for infected sternotomy wounds. Ann Surg 1991;213:583.
7. Jurkiewicz MJ, Bostwick J, Hester TR, Bishop JB, Craver J. Infected median sternotomy wound. Successful treatment by muscle flaps. Ann Surg 1979;191: 738.
8. Nahai F, Rand RP, Hester TR, Bostwick J, Jurkiewicz MJ. Primary treatment of infected sternotomywound with muscle flaps: A review of 211 consecutive cases. Plast Reconstr Surg 1989;84: 434.
9. Ringleman PR, Vander Kolk CA, Cameron D, Baumgartner WA, Manson PN. Long-term results of flap reconstruction in median sternotomy wound infections. Plast Reconstr Surg 1994; 93: 1208.
10. Lopez-Monjardin H, De-la-Pena-Salcedo A, MendozaMunoz M, Lopez-Yanez-de-la-Pena A, Palacio-Lopez E, Lopez-Garcia A. Omentum flap versus pectoralis major flap in the treatment of mediastinitis. Plast Reconstr Surg 1998;101:1481.
11. Lee AB, Schimert G, Shaktin S, Seigel JH. Total excision of the sternum and thoracic pedicle transposition of the greater omentum; useful stratagems in managing severe mediastinal infections following open heart surgery. Surgery 1976; 80: 433.
12. Patel NV, Woznick AR, Welsh KS, Bendick PJ, Boura JA, Mucci SJ. Predictors of mortality after muscle flap advancement for deep sternal wound infections. Plast Reconstr Surg 2009;123: 132-8.
13. Spartalis E, Markakis C, Moris D, Lachanas E, Agathos EA, Karakat Sani A, Karagkiouzis G, Athanasiou A, Dimitroulis D, Tomos P. Results of the modified bipectoral muscle flap procedure for post-sternotomy deep wound infection. Surg Today 2016;46:460–5.
14. Wu S, Wan F, Gao YS, Zhang Z, Zhao H, Cui ZQ, Xie JY. Sternal reconstruction of deep sternal wound infections following median sternotomy by single-stage muscle flaps transposition. Chin Med Sci J 2014;29:208– 13.
15. Brito Jde D, Assumpção CR, Murad H, Jazbik Ade P, Sá MP, Bastos ES, Giambroni Filho R, Souza e Silva R. Onestage management of infected sternotomy wounds using bilateral pectoralis major myocutaneous advancement flap. Rev Bras Cir Cardiovasc 2009;24: 58–63.
16. Ortak T, Uraloglu M, Uysal AC, Orbay H, Tekin F, Sensöz Ö, Uraloglu G. Reconstruction of sternal defects with pectoralis major muscle flap. Eur J Plast Surg 2008;30:223–8.
17. Albacete Neto A, Coltro PS, Horácio GS, Almeida IR, Farina Junior JA. Unilateral pectoralis major muscle flap for the treatment of sternal wounds due to Ludwig’s angina. Int Wound J 2018;15(1):174-7.