Microsurgical reconstruction using thoracoacromial vessels as recipients for complicated chest wall defects

IF 1.5 3区 医学 Q3 SURGERY
Microsurgery Pub Date : 2024-03-26 DOI:10.1002/micr.31164
Jisu Kim MD, Kyeong-Tae Lee MD, PhD
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引用次数: 0

Abstract

Background

Free tissue transfer is often required for the reconstruction of complex and deep anterior chest wall wounds, for which the identification of suitable recipient vessels is crucial. Although the internal mammary arteries (IMAs) are a representative option, identifying secondary options when these vessels are compromised remains a challenge. This report evaluated the efficacy of using the thoracoacromial vessels (TAVs) as recipients for chest wall reconstruction by reviewing our experience.

Methods

We conducted a retrospective review of patients undergoing free-flap-based chest wall reconstruction using TAVs as recipient vessels from February 2020 to March 2023. Patient demographics and surgery-related characteristics data were collected. The primary outcome of interest was the occurrence of flap perfusion-related complications.

Results

In total, 12 cases utilized TAVs as recipients, primarily for defects following sternotomy, where bilateral IMA was unavailable due to prior surgery. The TAVs with reliable perfusion were consistently identified beneath the pectoralis major muscle. The anterolateral thigh flap was predominantly employed, with musculocutaneous or chimeric flaps introduced for bony defects. The mean pedicle length of the harvested flap was 7.2 cm (range, 3–13), and in cases with a vascular gap, the pedicle was extended using an arteriovenous interposition graft. This resulted in a mean pedicle length needed to reach recipient vessels of 9.9 cm (range, 6.5–19). All flaps survived, with only one experiencing partial necrosis.

Conclusions

The TAV could be considered as an attractive alternative recipient vessel in microsurgical reconstruction of complicated chest wall defects when the use of IMA is not feasible.

利用胸骶骨血管作为复杂胸壁缺损的受体进行显微外科重建。
背景:在重建复杂的深前胸壁伤口时,经常需要进行游离组织转移,为此,确定合适的受体血管至关重要。虽然乳内动脉(IMA)是一种具有代表性的选择,但当这些血管受损时,确定次要选择仍然是一项挑战。本报告通过回顾我们的经验,评估了使用胸锁乳突肌血管 (TAV) 作为胸壁重建受体的有效性:我们对 2020 年 2 月至 2023 年 3 月期间使用 TAV 作为受体血管进行基于游离瓣的胸壁重建的患者进行了回顾性研究。我们收集了患者的人口统计学和手术相关特征数据。主要研究结果为皮瓣灌注相关并发症的发生率:共有 12 个病例使用 TAV 作为受体,主要用于胸骨切开术后的缺损,由于之前的手术无法使用双侧 IMA。具有可靠灌注的 TAV 始终位于胸大肌下方。主要采用大腿前外侧皮瓣,骨性缺损则采用肌皮或嵌合皮瓣。切除皮瓣的平均蒂长为7.2厘米(范围为3-13厘米),在有血管间隙的病例中,使用动静脉插管移植延长蒂长。这样,到达受体血管所需的瓣蒂平均长度为 9.9 厘米(6.5-19 厘米)。所有皮瓣都存活了下来,只有一个皮瓣部分坏死:结论:在无法使用 IMA 的情况下,TAV 可被视为显微外科重建复杂胸壁缺损的一种有吸引力的替代受体血管。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Microsurgery
Microsurgery 医学-外科
CiteScore
3.80
自引率
19.00%
发文量
128
审稿时长
4-8 weeks
期刊介绍: Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.
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