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Soft-tissue reconstruction in thoracic surgery

K M al-Kattan1, N M Breach, D K Kaplan

  • 1Royal Brompton Hospital, London, United Kingdom.

The Annals of Thoracic Surgery
|November 1, 1995
PubMed
Summary
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Omental and myocutaneous flaps effectively reconstruct infected sternotomy wounds and thoracic defects. Omentum is ideal for infected cases, while rectus muscle flaps yield excellent results, reserving free flaps for complex, non-infected situations.

Area of Science:

  • Thoracic Surgery
  • Plastic Surgery
  • Reconstructive Surgery

Background:

  • Omental and myocutaneous flaps are standard for infected sternotomy wounds.
  • This study retrospectively reviews their application in thoracic reconstruction over five years.

Purpose of the Study:

  • To evaluate the efficacy and safety of omental and myocutaneous flaps in thoracic reconstruction.
  • To assess their role in managing infected sternotomy wounds and chest wall defects.

Main Methods:

  • Retrospective review of 30 patients (19 men, 11 women) aged 43-75.
  • Complex omental and myocutaneous flaps used for soft-tissue cover (18 patients) and obliterating intrathoracic cavities (12 patients).
  • Rectus muscle flaps (11/24) and omental flaps (12/30) utilized; 23 rotational and 7 free microvascular flaps performed.

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Main Results:

  • No operative deaths occurred.
  • Three complications: two free flap losses requiring revision, one prosthesis infection treated with drainage and rib resection.
  • Primary surgical goals were achieved in all other cases without complications.

Conclusions:

  • The omentum's vascularity supports its use, particularly in preoperatively infected cases.
  • Rectus muscle complex myocutaneous flaps demonstrate excellent outcomes.
  • Free flaps are best reserved for complex, non-infected thoracic reconstruction challenges.