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Related Concept Videos

Flail Chest-II01:26

Flail Chest-II

242
Managing flail chest, a condition characterized by a segment of the chest wall moving independently from the rest of the thoracic cage, requires a comprehensive approach. It includes a thorough assessment of the patient's condition, a diagnostic evaluation to determine the extent of the injury, and the implementation of appropriate medical interventions tailored to the individual's needs.
Assessment:
1. Clinical Evaluation:
History:
242
Flail Chest-I01:24

Flail Chest-I

295
Overview of Flail Chest
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
Pathophysiology
The pathophysiology of flail chest is complex, involving fractures of...
295

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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
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Pectoralis Major Flaps for Sternal Reconstruction: Multidisciplinary Considerations and Patient Outcomes.

David Chi1, Rachel Skladman1, Reme E Arhewoh1

  • 1From the Division of Plastic and Reconstructive Surgery, Department of Surgery Washington University Medical Center, Saint Louis, MO.

Annals of Plastic Surgery
|June 18, 2025
PubMed
Summary

Pectoralis flaps are key for cardiothoracic surgery sternal wound reconstruction. Absence of the internal mammary artery influences flap choice, while specific flap types impact recurrence, with CAD and prior surgeries predicting readmission.

Keywords:
cardiothoracic surgerycoronary artery diseasepectoralis majorplastic surgeryreconstructionsternal wound

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Area of Science:

  • Cardiothoracic Surgery
  • Plastic Surgery
  • Wound Reconstruction

Background:

  • Sternal wounds post-cardiothoracic surgery present significant reconstructive challenges.
  • Pectoralis muscle flaps are a primary method for sternal wound closure.
  • Variations in pectoralis flap techniques necessitate understanding decision factors and outcomes.

Purpose of the Study:

  • To characterize key decision factors in pectoralis flap reconstruction for sternal wounds.
  • To analyze patient outcomes associated with different pectoralis flap techniques.
  • To enhance the accessibility and application of these reconstructive strategies.

Main Methods:

  • Retrospective cohort study of 114 adult sternal wound patients (2010-2020).
  • Collected data included demographics, comorbidities, wound characteristics, and perioperative factors.
  • Multinomial and binomial logistic regression analyzed reconstructive technique associations and 90-day outcomes.

Main Results:

  • Bilateral advancement flaps were most common (64%).
  • Absence of the internal mammary artery correlated with bilateral flap use (P < 0.01).
  • Turnover flaps were associated with deep space wounds (P < 0.001), and flap type impacted recurrence (P < 0.03).
  • Coronary artery disease (OR=8.18), prior surgeries (OR=2.95), and early discharge (OR=3.73) predicted 90-day readmission/reoperation.

Conclusions:

  • Pectoralis major flap configurations offer versatile sternal wound treatment.
  • Internal mammary artery status is crucial for selecting bilateral flap reconstruction.
  • Turnover flaps suit deep space wounds; clear communication on IMA patency aids multidisciplinary care.