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Vascularized muscle flaps for life-threatening mediastinal wounds in children
C L Backer1, J M Pensler, G R Tobin
1Department of Surgery, Northwestern University, Chicago, Illinois.
Insights
Vascularized muscle flaps effectively treat pediatric mediastinal wounds, achieving an 85% healing rate. This technique is crucial for infection control and life preservation in children with complex thoracic injuries.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Wound Healing
Background:
- Vascularized muscle flaps are established treatments for adult mediastinal wounds, offering infection control and coverage.
- Experience with these flaps in pediatric populations is limited, particularly for life-threatening conditions.
Observation:
- This study reviewed 8 pediatric patients (1 day to 10 years) with severe mediastinal wounds treated with vascularized muscle flaps between 1985 and 1993.
- Indications included mediastinitis, exposed grafts/conduits, cardiac defects, tracheal dehiscence, sternal instability, and post-transplant complications.
Findings:
- Seven of eight patients (85%) achieved successful mediastinal wound healing using pectoralis major, rectus abdominis, or cervical strap flaps.
- One infant with asplenia and an exposed graft died of Candida sepsis despite flap intervention.
Implications:
- Prompt surgical intervention with vascularized muscle flaps is vital for managing pediatric thoracic wound complications.
- This approach promotes rapid healing and improves outcomes in critically ill children with mediastinal defects.
Abstract:
Vascularized muscle flaps have been shown to be highly effective in adults for complicated mediastinal and thoracic wounds. They result in infection control, wound coverage, and preservation of life. Minimal experience exists with the use of these techniques in children. We review our experience with vascularized muscle flaps between 1985 and 1993 in treating life-threatening mediastinal wounds in 8 children. The 8 patients ranged in age from 1 day to 10 years; mean age was 2 years. Two patients had mediastinitis; one had an exposed Gore-Tex graft, and the other had an exposed homograft conduit. One patient had a midline defect with exposed right ventricle immediately beneath the skin. One patient had tracheal dehiscence after repair of an acquired tracheoesophageal fistula from battery erosion. One patient with Marfan's syndrome had a pectus deformity and an unstable sternum after emergent reoperation for a false aortic aneurysm. Two neonates had their sternum left open with a temporary Silastic skin patch after orthotopic cardiac transplantation because of swelling of the donor heart. One transplant patient had wound dehiscence. Vascularized muscle flaps used to heal the mediastinal wounds in this group included pectoralis major (10), rectus abdominis (3), and cervical strap (1). One infant with asplenia and an exposed Gore-Tex graft that had a delayed vascularized muscle flap died of Candida sepsis. Seven of 8 patients (85%) healed their mediastinal wound. Prompt recognition of thoracic wound complications facilitates immediate surgical intervention to obtain primary closure with vascularized muscle flaps, which promotes rapid healing in these children.