Download PDF
Handchir Mikrochir Plast Chir 2023; 55(06): 437-442
DOI: 10.1055/a-2060-0814
Originalarbeit

Die Split-Turnover-Pectoralislappenplastik: eine einfache und sichere Methode zur Deckung sternaler Defekte

The split turnover pectoralis muscle flap: an easy and safe method for sternal wound coverage
Claas Spengler
1   Klinik für Plastische und Ästhetische Chirurgie, HELIOS Kliniken Schwerin, Schwerin, Germany
,
Frank Masberg
1   Klinik für Plastische und Ästhetische Chirurgie, HELIOS Kliniken Schwerin, Schwerin, Germany
,
Roland Mett
1   Klinik für Plastische und Ästhetische Chirurgie, HELIOS Kliniken Schwerin, Schwerin, Germany
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Zusammenfassung

Die Pectoralis-Muskellappenplastik ist zur Deckung sternaler Defekte nach tiefer sternaler Wundinfektion weit verbreitet. Sie kann entweder als klassischer Advancement-Flap, gestielt an der A. thoracoacromialis, oder als Turnover-Flap, gestielt an den interkostalen Perforatoren der A. thoracica interna, gehoben werden. Der Advancement-Flap hat den Nachteil, dass eine Bedeckung des inferioren Sternumdrittels oft nicht erzielt werden kann, während der Turnover-Flap zwar das inferiore und mediale Drittel bedeckt, oft aber im kranialen Drittel nicht ausreicht. Die Autoren beschreiben eine neuartige Methode zum Breitengewinn der Turnover-Pectoralis-Lappenplastik durch Aufsplitten dieser entlang der Muskelfasern.Bei allen zwölf Patienten, die zwischen 2017 und 2022 mit dieser Methode behandelt wurden, konnte eine vollständige Abheilung sowie ein Wundverschluss erzielt werden. Die Split-Pectoralis-Lappenplastik stellt damit eine sichere und effektive Methode zur Defektdeckung sternaler Defekte dar.

Abstract

The conventional pectoralis muscle flap is well known for the reconstruction of sternal defects after deep sternal wound infection. The pectoralis muscle flap can be harvested as an advancement flap based on the thoracoacromial artery, or it can be harvested as a turnover flap based on intercostal perforators of the internal thoracic artery. A disadvantage of the advancement flap can be seen in its limited reach, especially for covering the lower third of the sternum. The turnover flap is well suited for coverage of the lower and middle sternal third, but then lacks the length for coverage of the cranial third. The authors describe a new method for splitting up the pectoralis turnover muscle flap along its muscle fibres in order to gain additional length. Between 2017 and 2022, we treated 12 patients with this method. Total wound coverage and closure have been achieved in all 12 patients. Thus, the split turnover pectoralis flap is a safe and effective method for sternal wound treatment.

Schlüsselwörter

Pectoralislappenplastik - Sternale Wundheilungsstörung - TSWI - tiefe sternale Wundheilungsstörung

Key words

deep sternal wound infection - chest wall reconstruction - sternal wound - pectoralis flap - turnover flap - split flap


Publication History

Received: 08 February 2023

Accepted: 13 March 2023

Article published online:
27 June 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Gummert JF, Barten MJ, Hans C. et al. Mediastinitis and cardiac surgery—an updated risk factor analysis in 10,373 consecutive adult patients. Thorac Cardiovasc Surg 2002; 50: 87-91
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Losanoff JE, Richman BW, Jones JW.. Disruption and infection of median sternotomy: a comprehensive review. Eur J Cardiothorac Surg 2002; 21: 831-839
    CrossrefPubMedSearch in Google Scholar
  • 3 Jurkiewicz MJ, Bostwick J, Hester TR. et al. Infected median sternotomy wound. Successful treatment by muscle flaps. Ann Surg 1980; 191: 738-44
    CrossrefPubMedSearch in Google Scholar
  • 4 Piwnica-Worms W, Azoury SC, Kozak G, Nathan S. et al. Flap Reconstruction for Deep Sternal Wound Infections: Factors Influencing Morbidity and Mortality. Ann Thorac Surg 2020; 109 (05) 1584-1590
    CrossrefPubMedSearch in Google Scholar
  • 5 Rikimaru H, Kiyokawa K, Inoue Y. et al. Three-Dimensional Anatomic Vascular Distribution in the Pectoralis Major Myocutaneous Flap. PRS 2005; 115 (05) 1342-52
    CrossrefPubMedSearch in Google Scholar
  • 6 Spiess A, Balakrishnan C, Gursel E.. Fascial Release of the Pectoralis Major: A Technique Used in Pectoralis Major Muscle Closure of the Mediastinum in Cases of Mediastinitis. PRS 2007; 119: 573-577
    CrossrefPubMedSearch in Google Scholar
  • 7 Wong MS, Erdmann D, Levin L.. Split Turnover Pectoralis Muscle Flap for the Treatment of Sternal Osteomyelitis. PRS 2008; 121: 1063-1064
    CrossrefPubMedSearch in Google Scholar
  • 8 Brown RH, Sharabi SE, Kania KE. et al. The Split Pectoralis Flap: Combining the Benefits of Pectoralis Major Advancement and Turnover Techniques in One Flap. PRS 2017; 139: 1474-1477
    CrossrefPubMedSearch in Google Scholar
  • 9 Eriksson J, Huljebrant I, Nettelblad H. et al. Functional Impaiment After Treatment With Pectoral Muscle Flaps Because of Deep Sternal Wound Infection. Scand Cardiovasc J 2011; 45: 174-80
    CrossrefPubMedSearch in Google Scholar
  • 10 Zhang H, Ling J, Yang H. et al. Bilateral partial pectoralis major muscle turnover flaps for the management of deep sternal wound infection following cardiac surgery. J Thorac Dis 2020; 12: 6010-6015
    CrossrefPubMedSearch in Google Scholar