In our case, extension across the sternum to the right hemithorax was required for exposure of pleural, anterior, and mediastinal selleck kinase inhibitor structures. Horizonal transection of the sternum during EDT required ligation of the internal mammary arteries, which lie approximately 1.57 ± 0.30 cm lateral from the right and 1.47 ± 0.30 cm lateral from
the left of the sternal edge . Bilateral transection of the internal mammary vessels proximal to the terminal bifurcation during an EDT interrupted the superiorly based blood supply of the both rectus abdominis muscles, precluding the possibility of a superiorly based rectus abdominis flap from either side for wound reconstruction (Figure 5). Therefore, we addressed the given limitations by utilizing a free flap reconstruction of the EDT wound.
Because of the suitability with regards to its dimensions, proximity to the defect, and large caliber vascular pedicle, the rectus abdominis muscle was used as a free flap for wound reconstruction. The right internal mammary vessels proximal selleck chemical to the transection level were anastomosed to the deep inferior epigastric vessels (dominant pedicle) of the flap for perfusion. In the event of rare EDT wound complication requiring reconstruction, the integrity and patency of the internal mammary vasculature must be carefully assessed for the potential use of rectus abdominis muscles as a pedicled flap. Nevertheless, the possibility of using the rectus abdominis flap based on the superior epigastric vasculature would be remote in most cases, other flaps such as pectoralis major and latissimus
dorsi flaps will not reach to the wound and reconstructive surgery by using free tissue transfer would be required. References 1. Cothren CC, Moore EE: Emergency SCH 900776 manufacturer department thoracotomy for the critically injured patient: objectives, indications, and outcomes. World J Emerg Surg 2006, 1:4.CrossRefPubMed 2. Ninkovic MM, Schwabegger AH, Anderl H: Internal mammary vessels as a recipient site. Clin Plast Surg 1998, 25:213–221.PubMed 3. Davison SP, Clemens MW, Armstrong D, Flucloronide Newton ED, Swartz W: Sternotomy wounds: Rectus flap versus modified pectoral reconstruction. Plast Reconstr Surg 2007, 120:929–34.CrossRefPubMed 4. Roth DA: Thoracic and abdominal wall reconstruction. In Grabb and Smith’s Plastic Surgery. Edited by: Aston, SJ, Beasley RW, Thorne CHM. Philadelphia: Lippincott-Raven Publishers; 1997:1023–1029. 5. Williams PL, Warwick R, Dyson M, Bannister LH, eds: Angiology. In Gray’s Anatomy. 37th edition. New York: Churchill livingstone; 1989:754–755. 6. Glassberg RM, Sussman SK, Glickstein MF: CT anatomy of the internal mammary vessels: importance in planning percutaneous transthoracic procedures. AJR Am J Roentgenol 1990, 155:397–400.PubMed Competing interests The authors declare that they have no competing interests. Authors’ contributions KG: has been involved in drafting the manuscript. KI: assisted the free flap reconstruction surgery.