Management of thoracic aortic graft infections with combined omental and bilateral pectoralis major flaps

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery Pub Date : 2024-09-10 DOI:10.1016/j.bjps.2024.09.016

Kevin G. Kuonqui , Myles N. LaValley , Sarah E. Diaddigo , David E. Janhofer , Hiroo Takayama , Jeffrey A. Ascherman

{"title":"Management of thoracic aortic graft infections with combined omental and bilateral pectoralis major flaps","authors":"Kevin G. Kuonqui , Myles N. LaValley , Sarah E. Diaddigo , David E. Janhofer , Hiroo Takayama , Jeffrey A. Ascherman","doi":"10.1016/j.bjps.2024.09.016","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Aortic vascular graft/endograft infection (VGEI) has historically been managed through graft removal and re-replacement, but new approaches suggest vascularized tissue transfer is an effective adjunctive treatment. We describe our experience with treating thoracic aortic vascular graft infection with combined omental and bilateral pectoralis major myocutaneous (PMM) advancement flaps.</div></div><div><h3>Methods</h3><div>Data from all patients undergoing combined flap closure by the senior author at a high-acuity cardiac surgery center from 1995–2023 were reviewed. Patients with clinical and radiographic signs of thoracic aortic vascular graft infection were included.</div></div><div><h3>Results</h3><div>Complete data were available for 598 patients with sternal and mediastinal wounds. Combined PMM and omental flaps were mobilized in 11 thoracic aortic vascular graft infection patients. Indications for flap management included culture-positive infection (8/11; 72.7%), dehiscence (5/11; 45.5%), drainage (7/11; 63.6%), and inability to close the sternotomy due to hemodynamic instability (5/11; 45.5%). During chest exploration, 6/11 (54.5%) underwent complete removal of the infected graft, compared to 5/11 (45.5%) who underwent graft-preserving washout and debridement. Immediate flap closure was performed in 6/11 (54.5%). Postoperative complications included dehiscence (2/11; 18.2%), seroma (1/11; 9.1%), hematoma (1/11, 9.1%), abdominal hernia (1/11; 9.1%), and recurrent infection (1/11; 9.1%). One patient (9.1%) died within 30 days of sternal reconstruction from mitral valve failure tachyarrhythmia. None of the patients underwent reoperation for flap-related complications.</div></div><div><h3>Conclusions</h3><div>Despite significant comorbidities, low postoperative morbidity and mortality indicate that combined omental and pectoralis major flaps are a safe and effective adjunctive treatment to the antimicrobial and surgical management of select thoracic aortic vascular graft infections.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0000,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Plastic Reconstructive and Aesthetic Surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1748681524005679","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Aortic vascular graft/endograft infection (VGEI) has historically been managed through graft removal and re-replacement, but new approaches suggest vascularized tissue transfer is an effective adjunctive treatment. We describe our experience with treating thoracic aortic vascular graft infection with combined omental and bilateral pectoralis major myocutaneous (PMM) advancement flaps.

Methods

Data from all patients undergoing combined flap closure by the senior author at a high-acuity cardiac surgery center from 1995–2023 were reviewed. Patients with clinical and radiographic signs of thoracic aortic vascular graft infection were included.

Results

Complete data were available for 598 patients with sternal and mediastinal wounds. Combined PMM and omental flaps were mobilized in 11 thoracic aortic vascular graft infection patients. Indications for flap management included culture-positive infection (8/11; 72.7%), dehiscence (5/11; 45.5%), drainage (7/11; 63.6%), and inability to close the sternotomy due to hemodynamic instability (5/11; 45.5%). During chest exploration, 6/11 (54.5%) underwent complete removal of the infected graft, compared to 5/11 (45.5%) who underwent graft-preserving washout and debridement. Immediate flap closure was performed in 6/11 (54.5%). Postoperative complications included dehiscence (2/11; 18.2%), seroma (1/11; 9.1%), hematoma (1/11, 9.1%), abdominal hernia (1/11; 9.1%), and recurrent infection (1/11; 9.1%). One patient (9.1%) died within 30 days of sternal reconstruction from mitral valve failure tachyarrhythmia. None of the patients underwent reoperation for flap-related complications.

Conclusions

Despite significant comorbidities, low postoperative morbidity and mortality indicate that combined omental and pectoralis major flaps are a safe and effective adjunctive treatment to the antimicrobial and surgical management of select thoracic aortic vascular graft infections.

查看原文本刊更多论文

用网膜和双侧胸大肌联合皮瓣治疗胸主动脉移植感染

背景主动脉血管移植物/内膜移植物感染（VGEI）一直以来都是通过移植物切除和重新置换来处理的，但新方法表明血管化组织转移是一种有效的辅助治疗方法。我们描述了用联合网膜和双侧胸大肌（PMM）推进皮瓣治疗胸主动脉血管移植物感染的经验。方法回顾了 1995-2023 年间由资深作者在一家高难度心脏外科中心进行联合皮瓣闭合手术的所有患者的数据。结果有598名胸骨和纵隔伤口患者的完整数据。在 11 例胸主动脉血管移植感染患者中，移动了 PMM 和网膜瓣。皮瓣处理的指征包括培养阳性感染（8/11；72.7%）、开裂（5/11；45.5%）、引流（7/11；63.6%）以及因血流动力学不稳定而无法关闭胸骨切开术（5/11；45.5%）。在胸腔探查过程中，6/11（54.5%）人完全切除了受感染的移植物，而 5/11（45.5%）人则进行了保留移植物的冲洗和清创。6/11（54.5%）例患者立即进行了皮瓣缝合。术后并发症包括裂开（2/11；18.2%）、血清肿（1/11；9.1%）、血肿（1/11，9.1%）、腹部疝（1/11；9.1%）和复发性感染（1/11；9.1%）。一名患者（9.1%）在胸骨重建后30天内死于二尖瓣关闭不全快速性心律失常。结论尽管合并症显著，但术后发病率和死亡率较低，这表明网膜和胸大肌联合皮瓣是一种安全有效的辅助治疗方法，可用于选择性胸主动脉血管移植感染的抗菌和手术治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Plastic Reconstructive and Aesthetic Surgery 医学-外科

CiteScore

3.10

自引率

11.10%

发文量

578

审稿时长

3.5 months

期刊介绍： JPRAS An International Journal of Surgical Reconstruction is one of the world''s leading international journals, covering all the reconstructive and aesthetic aspects of plastic surgery. The journal presents the latest surgical procedures with audit and outcome studies of new and established techniques in plastic surgery including: cleft lip and palate and other heads and neck surgery, hand surgery, lower limb trauma, burns, skin cancer, breast surgery and aesthetic surgery.