Thomas J Francel, MD, Nicholas T Kouchoukos, MD

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Presentation transcript:

A rational approach to wound difficulties after sternotomy: reconstruction and long-term results Thomas J Francel, MD, Nicholas T Kouchoukos, MD The Annals of Thoracic Surgery Volume 72, Issue 4, Pages 1419-1429 (October 2001) DOI: 10.1016/S0003-4975(00)02009-9

Fig 1 The defect after sternectomy following coronary artery bypass graft and prior radiation is extensive (A). A latissimus dorsi myocutaneous flap was rotated into position (B) because of unavailability of the chest and abdominal muscles. The Annals of Thoracic Surgery 2001 72, 1419-1429DOI: (10.1016/S0003-4975(00)02009-9)

Fig 2 An aortic root graft infected with Candida species (A) is covered and wrapped with an omental pedicle flap (B). The Annals of Thoracic Surgery 2001 72, 1419-1429DOI: (10.1016/S0003-4975(00)02009-9)

Fig 3 A rectus myocutaneous flap was selected in this patient because of the depth of the mediastinal defect. On postoperative computed tomographic scan (A), the rectus muscle (R) and the overlying subcutaneous tissue has completely filled this deep defect and allows soft tissue healing between the sternal edges (S). The patient has a visible cutaneous portion (B) but few patients have requested excision of this at a later date. The Annals of Thoracic Surgery 2001 72, 1419-1429DOI: (10.1016/S0003-4975(00)02009-9)

Fig 4 When the mediastinum is reexplored after muscle flap reconstruction, it is important to start in the superior mediastinum where the muscle flap (M) can be raised off the superior mediastinal structures and the hemisternum (S). We have found this plane to be particularly easy to identify, although the inferior plane directly over the heart is much more difficult to identify. Do not cut through the muscle or it will be devascularized. The Annals of Thoracic Surgery 2001 72, 1419-1429DOI: (10.1016/S0003-4975(00)02009-9)