Omental pedicle grafting in the treatment of poststernotomy mediastinitis

Mediastinitis after median sternotomy may be life-threatening. It should be managed by providing adequate mediastinal drainage, removing all foreign material (including infected and dead tissues) and obliterating any dead space. Obliterating dead space may be difficult using the usual method of creating a vacuum with large-bore tubes. Alternative methods consist of muscle or omental transpositions. The authors describe the cases of two men who had mediastinitis, 1 week and 3 months respectively, after coronary artery bypass grafting. In both cases, the mediastinitis was treated successfully by omental pedicle grafting. From their experience, the authors recommend omental grafting as a method of obliterating a large mediastinal dead space when the sternal edges can be approximated but the space cannot be closed by conventional methods.     

Omental free flap for the treatment of serious scarring results in the head

Four cases of tumors and one case of unstable and chronically ulcerated scar of the scalp, treated with the omental free flap, are presented in this paper. In two cases the skull was reconstructed with an autologous bone graft. The final aesthetic result was good, bearing in mind the initial pathology. Received: 24 March 1999 / Accepted: 4 December 1999     

A new flap model in the rat: the pectoral skin flap

The purpose of this study was to describe a new axial-pattern experimental flap model in the rat. Wistar rats weighing 200 to 250 g were used in the experiment. In 15 rats, the superficial anatomy of the ventral thoracic region was studied by anatomic dissection, dye injection, and microangiography, using 5 rats in each group. The anatomic studies revealed that the ventral thoracic skin derives its principal blood supply from the long thoracic artery--a branch of the common thoracic artery. Based on these anatomic studies, the pectoral skin flap model, pedicled on the long thoracic vessels, was created in the rat. The flap is bounded medially by the midsternal line, laterally by the anterior axillary line, and superiorly and inferiorly by transverse lines passing at the level of the suprasternal notch and the xyphoid process respectively. In 5 animals, bilateral flaps (N = 10) were raised and replaced in situ. In 15 animals, oversized flaps were created by extending the flap for both a greater width (N = 10) and length (N = 10). Although all the flaps limited to the cutaneous territory as described were found to survive totally, oversized flaps underwent partial necrosis distally. The authors conclude that the pectoral flap is a simple and reliable skin flap model for future biological and pharmacological study because it is very easy to raise, has a consistent vascular pedicle, and has well-defined borders with consistent landmarks.     

Omental transfer for mediastinitis in a patient with early gastric cancer

We encountered a patient with mediastinitis after coronary artery bypass grafting and early gastric cancer requiring surgical resection. We treated the patient’s mediastinitis by omental transfer since complete resection of the malignancy did not require omentectomy. However, in the procedure for harvesting an omental flap, lymph nodes along the gastroepiploic artery (GEA) were left in the stomach for dissection after recovery from mediastinitis; the greater omentum was divided along the outside of the GEA, and was used as a flap based on the left GEA. After mediastinitis was successfully treated, the patient underwent distal gastrectomy and resection of lymph nodes, including those along the GEA. Although indication for omental transfer must be carefully considered when selecting this procedure for mediastinitis patients with malignancies of the abdomen, this technique of harvesting the greater omentum was useful in the present case of a mediastinitis patient with surgical indications of early gastric cancer.     

Use of nasolabial flap in facial plasty

Using nasolabial flaps, 32 facial plastic operations were carried out and satisfactory results were obtained in all 32 cases. There were ectropion of the upper lip in 16 cases, ectropion of the lower lid in 14 cases and inferior nasal defect in 2 cases. This nasolabial flap can be transferred directly or through subcutaneous tunnel to repair a minor defect of the lower lid, the upper lip or nose etc. It give the best color and texture match. The ratio of length to width of the flaps was 4 to 1 or lower. The donor site within 3 cm can be directly suture and its scar along the nasolabial crease is vague. The operation is simple and aesthetic result is good.     

阶梯形皮瓣成形术的临床应用

蹼状或条索状瘢痕挛缩的局部整复方法很多，而对于片状瘢痕挛缩尚缺乏有效的方法，尤其是较宽的片状瘢痕挛缩。结合Ｚ成形术和矩形瓣成形术设计了一种阶梯形皮瓣成形术。经临床应用于治疗片状瘢痕挛缩２４例，效果满意。片状瘢痕主轴延长度从８８％～１６８％，平均１１４％；皮瓣基本全部成活，片状挛缩消失，恢复或部分恢复功能，无任何并发症。适应于轻、中度萎缩性片状瘢痕或多条平行的蹼状瘢痕挛缩的整形治疗     

Omental free flap reconstruction in complex head and neck deformities

BACKGROUND: Microvascular free flaps continue to revolutionize coverage options in head and neck reconstruction. This article reviews our 25-year experience with omental free tissue transfers. METHODS: All patients who underwent free omental transfer to the head and neck region were reviewed. RESULTS: Fifty-five patients were included with omental transfers to the scalp (25%), craniofacial (62%), and neck (13%) region. Indications were tumor resections, burn wound, hemifacial atrophy, trauma, and moyamoya disease. Average follow-up was 3.1 years (range, 2 months-13 years). Donor site morbidities included abdominal wound infection, gastric outlet obstruction, and postoperative bleeding. Recipient site morbidities included partial flap loss in four patients (7%) total flap loss in two patients (3.6%), and three hematomas. CONCLUSIONS: The omental free flap has acceptable abdominal morbidity and provides sufficient soft tissue coverage with a 96.4% survival. The thickness \and versatility of omentum provide sufficient contour molding for craniofacial reconstruction. It is an attractive alternative for reconstruction of large scalp defects and badly irradiated tissue.     

矩形瓣成形术临床应用142例

临床应用矩形瓣成形术治疗全身各部位蹼状或条索状挛缩畸形,包括挛缩瘢痕畸形、先天性和瘢痕性严重内眦赘皮及先天性指蹼粘连畸形,共１４２例,取得了良好的疗效。作者认为该法整复蹼状畸形具有较大限度地增加主轴延长率,皮瓣血运可靠,受术部位畸形矫正充分,外形美观,免去供皮区的取皮术等优点,且操作简便、易于掌握。本文还讨论了该方法的设计要点和操作注意事项,认为比较其他局部皮瓣该法是矫正蹼状畸形的较好方法。     

A-T推进皮瓣修复产妇腹部直线切口瘢痕

目的:探讨A-T推进皮瓣修复腹直肌切口瘢痕的临床效果。方法:将下腹部瘢痕切除,形成长三角形创面,在创面邻近处设计A-T皮瓣,将两侧缺损松弛的腹直肌收紧缝合;A-T皮瓣向中间推进修复创面。自2006年6月～2011年6月共成形腹部瘢痕36例。结果:本组36例患者,术后皮瓣全部成活,无并发症发生。术后随访1～2年,切口纹理走向和腹部外形近似横切口,瘢痕轻微,腹部平整,效果满意。结论:A-T推进皮瓣是修复腹直肌切口瘢痕理想方法之一,术后腹部收紧,外形平整,基本达到横切口的外形。     

Omental pedicle flap for the management of postoperative bronchopleural fistulae

Nine patients, who had previously undergone pneumonectomy (3) or lobctomy (6), were treated for bronchopleural fistulae using a pedicled omental flap. After adequate evacuation of the pleural space and control of infection, the omentum was harvested with an intact gastroepiploic arch and through an upper midline laparotomy and then transferred to the affected hemithorax. Successful closure was achieved in all the cases. The empyema spaces got completely obliterated without any recurrences, leaving no cosmetic defect.     

麻醉与术后认知功能障碍的研究进展

麻醉的目标不仅是保障患者术中的安全与稳定,还包括追求术后的最佳恢复。术后认知功能障碍作为麻醉术后的并发症,日益受到麻醉界的关注,本文就麻醉及与麻醉相关的病理生理变化与术后认知功能障碍的相关关系进行综述。     

Bilateral pectoral myocutaneous advancement flaps and anatomic sternal wound reconstruction in cyanotic infants with mediastinitis

OBJECTIVE: The purpose of this study was to assess the results and applicability of a modified chest closure technique employing bilateral pectoral myocutaneous advancement flaps after sternal re-approximation for postoperative mediastinitis in cyanotic infants. METHODS: The study population is of a single surgeon's pediatric cardiac experience (n = 253) over a 2-year period. With retrospective hospital chart review six cases with deep sternal wound complications were identified (five mediastinitis and one hypoxemic wound necrosis). Sternal wound reconstruction was done with the above technique in all cases. Follow up was completed by outpatient record review and with telephone interviews. RESULTS: All six cases presented in this paper were neonates or infants with complex cyanotic cardiac malformations. Following chest wall reconstruction all had complete resolution of their mediastinitis with no mortality and no wound healing complications. Three of them have since undergone elective staged repair, with no evidence of residual wound infection. Two babies died during follow-up as a result of progressive respiratory compromise. CONCLUSION: For postcardiotomy mediastinitis in cyanotic infants we recommend limited debridement and anatomic sternal reconstruction supported by bilateral pectoral myocutaneous advancement flap closure.