Reconstruction of an emergency thoracotomy wound with free rectus abdominis flap: Anatomic and radiologic basis for the surgical technique.
An alcoholic 50-year-old male patient with a history of schizophrenia sustained stab wounds into both ventricles and left lung, and survived following an emergency department thoracotomy. The EDT wound, however became infected requiring serial debridements of soft tissue, rib cartilage and sternum. Regional flap options such as pectoralis major and latissimus dorsi muscle flaps could not be employed due to inadequate reach of these flaps. Additionally, bilateral transection of the internal mammary arteries during emergency thoracotomy eliminated the use of rectus abdominis muscles as pedicled flaps based on the superior epigastric vasculature. Therefore, the EDT wound was reconstructed by using the right rectus abdominis muscle as a free flap. The deep inferior epigastric vessels of the flap were anastomosed to the right internal mammary vessels proximal to their transection level in the third-forth intercostal space. The flap healed with no further wound complications.
Gilman
Kaitlyn
K
Department of Plastic and Reconstructive Surgery, Denver Health Medical Center, University of Colorado Health Sciences Center, 777 Bannock Street, Denver, 80204 Colorado USA. raffi.gurunluoglu@dhha.org.
Ipaktchi
Kyros
K
Moore
Ernest E
EE
Barnett
Carlton
C
Gurunluoglu
Raffi
R
World J Emerg Surg. 2006 Mar 24;1:4
16759407
Plast Reconstr Surg. 2007 Sep 15;120(4):929-934
17805121
AJR Am J Roentgenol. 1990 Aug;155(2):397-400
2115273
Clin Plast Surg. 1998 Apr;25(2):213-21
9627779