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

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

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