Anatomic and clinical considerations of an internal mammary artery harvest.
In an effort to understand the perceived correlation of internal mammary artery harvesting and wound healing difficulties in the inferior margins of the sternotomy incision, we showed the cutaneous vascular perfusion in the sternal and xiphoid areas by India ink injection studies in cadavers. With these studies, we demonstrated an inherent paucity of nutrient supply to the inferior sternum and xiphoid area. The classic internal mammary artery harvest further compromises the blood supply to these areas. We believe that limiting the most inferior dissection of the internal mammary artery and not including the distal bifurcation leaves intact the lateral musculophrenic nutrient supply to the inferior sternum and xiphoid area and to the ipsilateral abdominal rectus muscle. These guidelines will help to prevent ischemic complications of this area and may aid in reconstruction. If the bifurcation is harvested, we believe that the removal of the avascular xiphoid cartilage at the time of the initial bypass procedure may eliminate this as a potential septic focus.
Francel
T J
TJ
Division of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.
Dufresne
C R
CR
Baumgartner
W A
WA
O'Kelley
J
J
D000009:Abdominal Muscles / Q000098:blood supply; D000328:Adult; D000368:Aged; D002244:Carbon; D004396:Coloring Agents; D001026:Coronary Artery Bypass / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000033:anatomy & histology; D008297:Male; D008323:Mammary Arteries / Q000033:anatomy & histology* / Q000637:transplantation*; D008875:Middle Aged; D009132:Muscles / Q000637:transplantation; D012039:Regional Blood Flow; D012189:Retrospective Studies; D012272:Ribs / Q000098:blood supply; D013249:Sternum / Q000098:blood supply* / Q000601:surgery; D013348:Subclavian Artery / Q000033:anatomy & histology; D013524:Surgical Flaps / Q000379:methods; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery; D013895:Thoracic Arteries / Q000033:anatomy & histology; D013908:Thoracotomy / Q000009:adverse effects; D014680:Veins / Q000637:transplantation; D014945:Wound Healing; D014989:Xiphoid Bone / Q000098:blood supply
D004396:Coloring Agents; C028433:chinese ink; D002244:Carbon