Related Experiment Video
Updated: Nov 3, 2025
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Pedicled or skeletonized bilateral internal mammary artery harvesting - a meta- analysis and trial sequential
Sashini Iddawela1, Sophie L Mellor2, Syeda Anum Zahra3
1Department of General Surgery, University Hospitals Birmingham, Birmingham, UK.
Insights
Skeletonized internal mammary artery harvesting significantly reduces sternal wound infection risk compared to pedicled techniques in coronary artery bypass surgery. This method preserves vasculature, making it ideal for high-risk patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Surgical Techniques
Background:
- Bilateral internal mammary artery (BIMA) grafting is crucial for coronary artery bypass surgery (CABG).
- Harvesting techniques for BIMA, specifically skeletonized versus pedicled, have varying evidence regarding post-operative complications.
- Sternal wound infections (SWI) and ischemia are significant concerns following CABG.
Purpose of the Study:
- To compare the post-operative clinical outcomes of skeletonized BIMA versus pedicled BIMA harvesting in patients undergoing CABG.
- To evaluate the impact of BIMA harvesting technique on the risk of sternal wound infections and ischemia.
Main Methods:
- A comprehensive systematic review and meta-analysis of studies comparing skeletonized and pedicled BIMA harvesting.
- Included studies were identified through searches of MEDLINE, Scopus, EMBASE, Cochrane, and Google Scholar up to June 15, 2020.
- Pooled effects analysis and trial sequential analysis were performed on data from nine studies (3649 patients).
Main Results:
- The meta-analysis included one randomized controlled trial and eight observational studies.
- Skeletonized BIMA harvesting was associated with a significantly lower risk of sternal wound infection (OR 0.27, 95% CI 0.20-0.51, p < 0.00001).
- A total of 2050 patients underwent skeletonized BIMA grafting and 1599 underwent pedicled BIMA grafting.
Conclusions:
- Skeletonization of the internal mammary artery reduces the risk of sternal wound infections.
- Preserving vasculature through skeletonization enhances its utility, particularly in patients susceptible to sternal wound complications.
- The findings support the use of skeletonized BIMA harvesting to improve patient outcomes after CABG.
Objective:
There is varying evidence on the role of skeletonization of internal mammary artery in reducing the risk of sternal wound infections and ischemia following bilateral internal mammary artery grafting. Post-operative clinical outcomes of skeletonized bilateral internal mammary artery versus pedicled bilateral internal mammary artery harvesting in patients undergoing coronary artery bypass surgery were compared.
Methods:
A comprehensive electronic search was conducted using MEDLINE, Scopus, EMBASE, Cochrane database and Google Scholar from inception until 15 June 2020. All studies directly comparing skeletonized and pedicled bilateral internal mammary artery harvesting were included. Meta-analysis and trial sequential analysis were conducted.
Results:
Nine studies (one randomized controlled trial and eight observational studies) consisting of 3649 patients (2050 patients with skeletonized bilateral internal mammary artery grafting and 1599 patients with pedicled bilateral internal mammary artery grafting) were included. Pooled effects analysis and trial sequential analysis reported significantly lower risk of sternal wound infection with skeletonized bilateral internal mammary artery harvesting (OR 0.27, 95% CI 0.20-0.51, p < 0.00001).
Conclusions:
Skeletonization reduces the risk of sternal wound infections by preserving vasculature as much as possible. This facilitates its use in patients at high risk of sternal wound infection.
