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Sternum Defektlerinin Rekonstrüksiyonunda Güvenilir Bir Yöntem: Pektoralis Major Kas Flebi ile Negatif Basınçlı Yara Bakım Kombinasyonu

Year 2023, Volume: 9 Issue: 1, 8 - 13, 02.02.2023

Emrah Kağan Yaşar Can İlker Demir Halil Işık Ali Ahmet Arıkan Murat Şahin Alagöz

https://doi.org/10.30934/kusbed.951454

Abstract

Giriş: Sternotomi defektleri izole cilt ayrılması gibi hafif ya da mediastinit gibi ağır tablolarla karşımıza çıkabilir. Tedavi seçeneklerinin kombinasyonu tedaviyi destekleyebilir.
Yöntem: 2016-2020 yılları arasında pektoralis majör flebi ve negative basınçlı yara bakımı (VAC) kombinasyonuyla tedavi edilen hastalar retrospektif olarak incelendi. Demografik özellikler, yara kültüründe üreyen mikroorganizmalar, flep rekonstrüksiyonu tercihi, ameliyat sonrası hastanede kalış süresi, tam iyileşme, nüks ve ilişkili morbidite ve mortalite verileri değerlendirildi.
Bulgular: Toplam 13 hasta çalışmaya dahil edildi. Ortalama yaş 65.4 idi. Tüm hastaların koroner arter greftlenmesi ameliyatı hikayesi vardı. Hastaların 9 tanesinde yara kültürlerinde üreme vardı. Dört hastada Staphylococcus türleri, üçünde Klebsiella pneumoniae ve ikisinde Acinetobacter baumannii üredi. En sık eşlik eden hastalıklar %76 hipertansiyon ve %46 diabetes mellitus idi. Ortalama hastanede kalış süresi 23,4 gündü. Bir hasta ameliyat sonrası 7.günde öldü, ikisinde flep donör sahasında seroma, birinde hematom görüldü.
Sonuç: Ölü dokuların tamamen temizlenmesi sonrası pectoral defektin kombine pektoral kas flebi ve negative basınçlı yara bakımı ile onarılarak tedavi edilmesi etkili bir yöntemdir.

Keywords

mediastinit negatif basınçlı yara tedavisi pektoral kas flebi sternal rekonstrüksiyon

Thanks

Kocaeli Üniversitesi KVC yoğun bakım servisi çalışanlarına teşekkür ederiz.

References

  • Bagheri R, Tashnizi MA, Haghi SZ, et al. Therapeutic Outcomes of Pectoralis Major Muscle Turnover Flap in Mediastinitis. Korean J Thorac Cardiovasc Surg. 2015;48(4):258-264.
  • Francel TJ, Kouchoukos NT. A rational approach to wound difficulties after sternotomy: reconstruction and long-term results. Ann Thorac Surg. 2001;72(4):1419-1429.
  • Kaul P. Sternal reconstruction after post-sternotomy mediastinitis. J Cardiothorac Surg. 2017;12(1):94. Published 2017 Nov 2.
  • Jakob HG, Borneff-Lipp M, Bach A, et al. The endogenous pathway is a major route for deep sternal wound infection. Eur J Cardiothorac Surg. 2000;17(2):154-160.
  • Lepelletier D, Bourigault C, Roussel JC, et al. Epidemiology and prevention of surgical site infections after cardiac surgery. Med Mal Infect. 2013;43(10):403-409.
  • Schulman NH, Subramanian V. Sternal wound reconstruction: 252 consecutive cases. The Lenox Hill experience. Plast Reconstr Surg. 2004;114(1):44-48.
  • Ascherman JA, Patel SM, Malhotra SM, Smith CR. Management of sternal wounds with bilateral pectoralis major myocutaneous advancement flaps in 114 consecutively treated patients: refinements in technique and outcomes analysis. Plast Reconstr Surg. 2004;114(3):676-683.
  • Ennker IC, Pietrowski D, Vöhringer L, et al. Surgical debridement, vacuum therapy and pectoralis plasty in poststernotomy mediastinitis. J Plast Reconstr Aesthet Surg. 2009;62(11):1479-1483.
  • Jones G, Jurkiewicz MJ, Bostwick J, et al. Management of the infected median sternotomy wound with muscle flaps. The Emory 20-year experience. Ann Surg. 1997;225(6):766-778.
  • Hugo NE, Sultan MR, Ascherman JA, Patsis MC, Smith CR, Rose EA. Single-stage management of 74 consecutive sternal wound complications with pectoralis major myocutaneous advancement flaps. Plast Reconstr Surg. 1994;93(7):1433-1441.
  • Hamdi M, Van Landuyt K, de Frene B, Roche N, Blondeel P, Monstrey S. The versatility of the inter-costal artery perforator (ICAP) flaps. J Plast Reconstr Aesthet Surg. 2006;59(6):644-652.
  • Garner J, Jarvis W, Emori T, Horan T, Huges J. CDC definitions for nosocomial infections 1988. Am J Infect Conntrol. 1988;16:128–40.
  • Gårdlund B, Bitkover CY, Vaage J. Postoperative mediastinitis in cardiac surgery - microbiology and pathogenesis. Eur J Cardiothorac Surg. 2002;21(5):825-830.
  • Brown RH, Sharabi SE, Kania KE, Hollier LH Jr, Izaddoost SA. The Split Pectoralis Flap: Combining the Benefits of Pectoralis Major Advancement and Turnover Techniques in One Flap. Plast Reconstr Surg. 2017;139(6):1474-1477.
  • Wu S, Wan F, Gao YS, et al. Sternal reconstruction of deep sternal wound infections following median sternotomy by single-stage muscle flaps transposition. Chin Med Sci J. 2014;29(4):208-213.
  • Nahai F, Morales L Jr, Bone DK, Bostwick J 3rd. Pectoralis major muscle turnover flaps for closure of the infected sternotomy wound with preservation of form and function. Plast Reconstr Surg. 1982;70(4):471-474.
  • Yu AW, Rippel RA, Smock E, Jarral OA. In patients with post-sternotomy mediastinitis is vacuum-assisted closure superior to conventional therapy? Interact Cardiovasc Thorac Surg. 2013;17(5):861-865.
  • Klesius AA, Dzemali O, Simon A, et al. Successful treatment of deep sternal infections following open heart surgery by bilateral pectoralis major flaps. Eur J Cardiothorac Surg. 2004;25(2):218-223.
  • Jang YJ, Park MC, Park DH, Lim H, Kim JH, Lee IJ. Immediate debridement and reconstruction with a pectoralis major muscle flap for poststernotomy mediastinitis. Arch Plast Surg. 2012;39(1):36-41.

A Reliable Procedure for Reconstruction of the Sternum Defects: The Pectoralis Major Muscle Flap Combination with Negative Pressure Wound Therapy

Year 2023, Volume: 9 Issue: 1, 8 - 13, 02.02.2023

Emrah Kağan Yaşar Can İlker Demir Halil Işık Ali Ahmet Arıkan Murat Şahin Alagöz

https://doi.org/10.30934/kusbed.951454

Abstract

Objective: Sternotomy defects may present mildly as isolated skin separation or severely as mediastinitis. A combination of treatment options can support treatment.
Methods: Patients who were treated with pectoralis major flap with the combination of negative pressure wound therapy (NPWT) between 2016-2020, were retrospectively reviewed. Demographic features, microorganisms causing wound infection, flap reconstruction preference, time of hospitalization, remission, recurrence and associated morbidity and mortality data were evaluated.
Results: Thirteen patients were included with a mean age of 65.4 years. All patients previously underwent coronary artery bypass graft surgery. Wound cultures from patients were positive in nine (69%). Isolated microorganisms were Staphylococcus spp. (n=4), Klebsiella pneumoniae (n=3) and Acinetobacter baumannii complex (n=2). The most common comorbidities were hypertension (76%) and diabetes mellitus(46%). The average hospital stay was 23.4 days. One patient died on the seventh postoperative day, two had seromas at the flap donor site, and one had hematoma.
Conclusion: Pectoralis major muscle flap and NPWT after complete removal of dead tissues is an effective method to repair and treat sternum defects.

Keywords

mediastinitis negative pressure wound therapy pectoral muscle flap sternal reconstruction

References

  • Bagheri R, Tashnizi MA, Haghi SZ, et al. Therapeutic Outcomes of Pectoralis Major Muscle Turnover Flap in Mediastinitis. Korean J Thorac Cardiovasc Surg. 2015;48(4):258-264.
  • Francel TJ, Kouchoukos NT. A rational approach to wound difficulties after sternotomy: reconstruction and long-term results. Ann Thorac Surg. 2001;72(4):1419-1429.
  • Kaul P. Sternal reconstruction after post-sternotomy mediastinitis. J Cardiothorac Surg. 2017;12(1):94. Published 2017 Nov 2.
  • Jakob HG, Borneff-Lipp M, Bach A, et al. The endogenous pathway is a major route for deep sternal wound infection. Eur J Cardiothorac Surg. 2000;17(2):154-160.
  • Lepelletier D, Bourigault C, Roussel JC, et al. Epidemiology and prevention of surgical site infections after cardiac surgery. Med Mal Infect. 2013;43(10):403-409.
  • Schulman NH, Subramanian V. Sternal wound reconstruction: 252 consecutive cases. The Lenox Hill experience. Plast Reconstr Surg. 2004;114(1):44-48.
  • Ascherman JA, Patel SM, Malhotra SM, Smith CR. Management of sternal wounds with bilateral pectoralis major myocutaneous advancement flaps in 114 consecutively treated patients: refinements in technique and outcomes analysis. Plast Reconstr Surg. 2004;114(3):676-683.
  • Ennker IC, Pietrowski D, Vöhringer L, et al. Surgical debridement, vacuum therapy and pectoralis plasty in poststernotomy mediastinitis. J Plast Reconstr Aesthet Surg. 2009;62(11):1479-1483.
  • Jones G, Jurkiewicz MJ, Bostwick J, et al. Management of the infected median sternotomy wound with muscle flaps. The Emory 20-year experience. Ann Surg. 1997;225(6):766-778.
  • Hugo NE, Sultan MR, Ascherman JA, Patsis MC, Smith CR, Rose EA. Single-stage management of 74 consecutive sternal wound complications with pectoralis major myocutaneous advancement flaps. Plast Reconstr Surg. 1994;93(7):1433-1441.
  • Hamdi M, Van Landuyt K, de Frene B, Roche N, Blondeel P, Monstrey S. The versatility of the inter-costal artery perforator (ICAP) flaps. J Plast Reconstr Aesthet Surg. 2006;59(6):644-652.
  • Garner J, Jarvis W, Emori T, Horan T, Huges J. CDC definitions for nosocomial infections 1988. Am J Infect Conntrol. 1988;16:128–40.
  • Gårdlund B, Bitkover CY, Vaage J. Postoperative mediastinitis in cardiac surgery - microbiology and pathogenesis. Eur J Cardiothorac Surg. 2002;21(5):825-830.
  • Brown RH, Sharabi SE, Kania KE, Hollier LH Jr, Izaddoost SA. The Split Pectoralis Flap: Combining the Benefits of Pectoralis Major Advancement and Turnover Techniques in One Flap. Plast Reconstr Surg. 2017;139(6):1474-1477.
  • Wu S, Wan F, Gao YS, et al. Sternal reconstruction of deep sternal wound infections following median sternotomy by single-stage muscle flaps transposition. Chin Med Sci J. 2014;29(4):208-213.
  • Nahai F, Morales L Jr, Bone DK, Bostwick J 3rd. Pectoralis major muscle turnover flaps for closure of the infected sternotomy wound with preservation of form and function. Plast Reconstr Surg. 1982;70(4):471-474.
  • Yu AW, Rippel RA, Smock E, Jarral OA. In patients with post-sternotomy mediastinitis is vacuum-assisted closure superior to conventional therapy? Interact Cardiovasc Thorac Surg. 2013;17(5):861-865.
  • Klesius AA, Dzemali O, Simon A, et al. Successful treatment of deep sternal infections following open heart surgery by bilateral pectoralis major flaps. Eur J Cardiothorac Surg. 2004;25(2):218-223.
  • Jang YJ, Park MC, Park DH, Lim H, Kim JH, Lee IJ. Immediate debridement and reconstruction with a pectoralis major muscle flap for poststernotomy mediastinitis. Arch Plast Surg. 2012;39(1):36-41.
There are 19 citations in total.

Details

Primary Language English
Subjects Cardiovascular Surgery
Journal Section Original Article / Medical Sciences
Authors

Emrah Kağan Yaşar 0000-0003-0572-1248

Can İlker Demir 0000-0001-6725-031X

Halil Işık 0000-0003-3823-004X

Ali Ahmet Arıkan 0000-0002-9599-1577

Murat Şahin Alagöz 0000-0002-5521-7173

Publication Date February 2, 2023
Submission Date July 10, 2021
Acceptance Date January 15, 2023
Published in Issue Year 2023 Volume: 9 Issue: 1

Cite

APA Yaşar, E. K., Demir, C. İ., Işık, H., Arıkan, A. A., et al. (2023). A Reliable Procedure for Reconstruction of the Sternum Defects: The Pectoralis Major Muscle Flap Combination with Negative Pressure Wound Therapy. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi, 9(1), 8-13. https://doi.org/10.30934/kusbed.951454
AMA Yaşar EK, Demir Cİ, Işık H, Arıkan AA, Alagöz MŞ. A Reliable Procedure for Reconstruction of the Sternum Defects: The Pectoralis Major Muscle Flap Combination with Negative Pressure Wound Therapy. KOU Sag Bil Derg. February 2023;9(1):8-13. doi:10.30934/kusbed.951454
Chicago Yaşar, Emrah Kağan, Can İlker Demir, Halil Işık, Ali Ahmet Arıkan, and Murat Şahin Alagöz. “A Reliable Procedure for Reconstruction of the Sternum Defects: The Pectoralis Major Muscle Flap Combination With Negative Pressure Wound Therapy”. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi 9, no. 1 (February 2023): 8-13. https://doi.org/10.30934/kusbed.951454.
EndNote Yaşar EK, Demir Cİ, Işık H, Arıkan AA, Alagöz MŞ (February 1, 2023) A Reliable Procedure for Reconstruction of the Sternum Defects: The Pectoralis Major Muscle Flap Combination with Negative Pressure Wound Therapy. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi 9 1 8–13.
IEEE E. K. Yaşar, C. İ. Demir, H. Işık, A. A. Arıkan, and M. Ş. Alagöz, “A Reliable Procedure for Reconstruction of the Sternum Defects: The Pectoralis Major Muscle Flap Combination with Negative Pressure Wound Therapy”, KOU Sag Bil Derg, vol. 9, no. 1, pp. 8–13, 2023, doi: 10.30934/kusbed.951454.
ISNAD Yaşar, Emrah Kağan et al. “A Reliable Procedure for Reconstruction of the Sternum Defects: The Pectoralis Major Muscle Flap Combination With Negative Pressure Wound Therapy”. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi 9/1 (February 2023), 8-13. https://doi.org/10.30934/kusbed.951454.
JAMA Yaşar EK, Demir Cİ, Işık H, Arıkan AA, Alagöz MŞ. A Reliable Procedure for Reconstruction of the Sternum Defects: The Pectoralis Major Muscle Flap Combination with Negative Pressure Wound Therapy. KOU Sag Bil Derg. 2023;9:8–13.
MLA Yaşar, Emrah Kağan et al. “A Reliable Procedure for Reconstruction of the Sternum Defects: The Pectoralis Major Muscle Flap Combination With Negative Pressure Wound Therapy”. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi, vol. 9, no. 1, 2023, pp. 8-13, doi:10.30934/kusbed.951454.
Vancouver Yaşar EK, Demir Cİ, Işık H, Arıkan AA, Alagöz MŞ. A Reliable Procedure for Reconstruction of the Sternum Defects: The Pectoralis Major Muscle Flap Combination with Negative Pressure Wound Therapy. KOU Sag Bil Derg. 2023;9(1):8-13.
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