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Management of intrathoracic defects

R P Clay1, P G Arnold

  • 1Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota.

Clinics in Plastic Surgery
|July 1, 1993
PubMed
Summary

Intrathoracic muscle flaps, including the serratus anterior, pectoralis major, and latissimus dorsi, are effective for mediastinal coverage and infection control. These muscle transpositions can salvage complex cases, especially in irradiated patients with poor healing potential.

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Area of Science:

  • Thoracic surgery
  • Surgical reconstruction

Background:

  • Mediastinal infections and repairs present significant challenges.
  • Previous methods may not adequately address complex thoracic defects, especially in compromised patients.

Purpose of the Study:

  • To evaluate the utility of intrathoracic muscle flaps for mediastinal coverage and repair.
  • To assess the efficacy of these flaps in managing infections and salvaging compromised thoracic structures.

Main Methods:

  • Transposition of serratus anterior, pectoralis major, and latissimus dorsi muscles.
  • Utilizing dominant vascular axes for flap viability.
  • Employing the Clagett method for pleural cavity management.

Main Results:

  • These muscle flaps provide adequate coverage for mediastinal structures.
  • Transposition of latissimus dorsi and pectoralis major results in minimal cosmetic or functional defects.
  • Muscle flaps are effective in sealing fistulas and bolstering vascular or visceral repairs.
  • Intrathoracic muscle flaps can salvage previously unsalvageable situations, particularly in irradiated patients.

Conclusions:

  • Intrathoracic muscle flaps are valuable tools in thoracic surgery for coverage, repair, and infection control.
  • They offer a viable solution for complex cases, including those with poor healing potential.
  • Prophylactic use may prevent severe complications.

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