FATMA BİLGEN, ALPER URAL, MEHMET BEKERECİOĞLU

COMBINED USE OF PEDICULATED MUSCLE FLAP AND Z-PLASTY IN THE CLOSURE OF STERNAL WOUNDS IN HIGH-RISK PATIENTS

Objective: Since deep sternal wound infections following sternotomy is a life-threatening complication, optimal management of sternal wounds still of vital importance. This study presents our 10-year experience with the use of pediculated muscle flaps and multiple Z-plasty techniques in reconstruction and tension-free closure of deep sternal wound and skin defects. Material and Method: 14 patients with deep sternal wound infection referred to our clinic between 2006 and 2016 for the closure of their defects included in our study. Following aggressive debridement, all patients underwent closure of mediastinal defect using pediculated muscle flaps, whereas primary skin repair was performed in seven patients and another seven patients required multiple Z-plasties due to high skin tension. Results: The tension-free closure was performed in all patients. None of the patients developed muscle or skin flap necrosis. Of a total of three patients with postoperative complications, two of them developed seroma and one patient developed a hematoma. At a mean follow-up period of five years recovery was achieved with acceptable wound scar in patients who underwent repair with multiple Z-plasty techniques, Conclusion: Aggressive therapy with muscle flap reconstruction serves to reduce morbidity and mortality caused by sternal wound infection, whereas successful use of multiple Z-plasty techniques for skin closure allows the surgeon to perform tension-free closure and reduces the risk of skin necrosis, dehiscence and infections.

Amaç: Sternotomiyi takiben derin sternal yara enfeksiyonu hayati tehlike oluşturan bir komplikasyon olduğundan, sternal yaranın optimum yönetimi halen büyük önem taşımaktadır. Bu çalışmada, derin sternaldefekt ve cilt defektinde, rekonstrüksiyon ve gergin olmayan kapama elde etmek için pediküllü kas fleplerive çoklu zplasti tekniğininkullanımı ile ilgili 10 yıllık deneyimlerimiz sunulmaktadır. Materyal ve Metot: 2006-2016 yılları arasında derin sternal yara enfeksiyonu olan 14 hasta defekt kapatılması için kliniğimize sevk edildi. Tüm hastalarda agresif debridmansonrası mediastinaldefekti kapama pediküllü kas flepleri ile, deri kapanması ise birden fazla z-plasti kullanılarak yapıldı. Bulgular: Bütün hastalarda gergin olmayan bir defekt kapatılması sağlandı. Hiçbir kas ve deri flep nekrozu oluşmadı. Toplam 3 hastanın ikisinde seroma ve 1 hastada hemotom gibi postoperatif komplikasyonlar yaşadı. Ortalama 5 yıllık izlem (6 ay- 8 yıl) süresi sonunda tüm hastalarda kabul edilebilir yara izleriyle tam düzelme görüldü. Sonuç: Kas flebi rekonstrüksiyonu ile agresif tedavi, sternal yara enfeksiyonunun morbidite ve mortalitesini azaltmaya yardımcı olurken, cildin kapanması için çoklu z- plasti prosedürünün başarılı bir Ģekilde kullanılması, cerrahın minimal bir skarlagergin olmayan bir kapama elde etmesini ve ciltte nekroz, yara ayrıĢmasıve enfeksiyon riskini azaltmaktadır.

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