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The Annals of Thoracic Surgery, Vol 57, 797-801, Copyright © 1994 by The Society of Thoracic Surgeons
CL Backer, JM Pensler, GR Tobin and C Mavroudis
Vascularized muscle flaps have been shown to be highly effective in adults
for complicated mediastinal and thoracic wounds. They result in infection
control, wound coverage, and preservation of life. Minimal experience
exists with the use of these techniques in children. We review our
experience with vascularized muscle flaps between 1985 and 1993 in treating
life-threatening mediastinal wounds in 8 children. The 8 patients ranged in
age from 1 day to 10 years; mean age was 2 years. Two patients had
mediastinitis; one had an exposed Gore-Tex graft, and the other had an
exposed homograft conduit. One patient had a midline defect with exposed
right ventricle immediately beneath the skin. One patient had tracheal
dehiscence after repair of an acquired tracheoesophageal fistula from
battery erosion. One patient with Marfan's syndrome had a pectus deformity
and an unstable sternum after emergent reoperation for a false aortic
aneurysm. Two neonates had their sternum left open with a temporary
Silastic skin patch after orthotopic cardiac transplantation because of
swelling of the donor heart. One transplant patient had wound dehiscence.
Vascularized muscle flaps used to heal the mediastinal wounds in this group
included pectoralis major (10), rectus abdominis (3), and cervical strap
(1). One infant with asplenia and an exposed Gore-Tex graft that had a
delayed vascularized muscle flap died of Candida sepsis. Seven of 8
patients (85%) healed their mediastinal wound. Prompt recognition of
thoracic wound complications facilitates immediate surgical intervention to
obtain primary closure with vascularized muscle flaps, which promotes rapid
healing in these children.
ARTICLES
Vascularized muscle flaps for life-threatening mediastinal wounds in children
Department of Surgery, Northwestern University, Chicago, Illinois.
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