Reconstruction of chest wound with the pedicled 5th intercostal perforator flap of the internal thoracic artery: a report of 10 cases
10.3760/cma.j.cn441206-20240430-00112
- VernacularTitle:带蒂胸廓内动脉第5肋间穿支皮瓣修复胸骨区创面10例
- Author:
Rufei DENG
1
;
Yonghong ZHANG
;
Yanwei CHEN
;
Jiaxin CHEN
;
Ruchen JI
;
Zhenyu JIANG
;
Lijin ZOU
;
Xuhui DENG
;
Youlai ZHANG
Author Information
1. 南昌大学第一附属医院烧伤整形与创面修复医学中心，南昌 330006
- Publication Type:Journal Article
- Keywords:
Keloid;
Chest wound;
Perforator flap;
Internal thoracic artery;
Repair;
Microsurgical operation
- From:
Chinese Journal of Microsurgery
2024;47(6):614-619
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the feasibility and clinical efficacy of reconstruction of the soft tissue defect after keloidectomy and/or cicatricial ulcers excision caused by sternotomy with the 5th intercostal perforator flap of the internal thoracic artery.Methods:From September 2016 to August 2023, 10 patients with sternal keloids and/or sternal scar ulcers caused by sternotomy were treated in the Medical Centre of Burn Plastic Surgery and Wound Repair, the First Affiliated Hospital of Nanchang University. The soft tissue defect after resection reconstructed by the pedicled 5th intercostal perforator flap of the internal thoracic artery. The patients were 7 males and 3 females, aged 17-65 years, with an average age of 43 years. The history of sternal scar was 2-15 years, with an average of 5.5 years. And the sizes of sternal scars were 2.0 cm×6.5 cm-5.5 cm×10.0 cm. After admission, the patients firstly received surgery to remove sternal keloids and/or scar ulcers. The defects of soft tissue were found from 2.5 cm×7.0 cm to 6.0 cm×10.5 cm in size after surgery. Then one-stage reconstructive surgery were performed on all of the patients with a transposition of the pedicled 5th intercostal perforator flap of the internal thoracic artery. Flaps were harvested in surgery at 3.5 cm×7.5 cm-6.0 cm×11.0 cm in size. The donor sites of flaps were pulled and directly sutured. After the surgery, wound healing and flap survival were observed, through regular follow-ups at outpatient clinics, and via internet hospitals or WeChat reviews to monitor the colour and appearance of the flaps, recurrence of keloids and/or ulcers, the appearance of donor sites and the secondary dysfunction of surgery.Results:All incisions healed well after surgery, and all the pedicled 5th intercostal perforator flaps of the internal thoracic artery survived. All 10 patients were included in the postoperative follow-up for a period of 6-31 months, with an average of 15 months. During follow-up, the colour and appearance of the flaps were found good, and the patients were satisfied. There was no recurrence of keloid and/or scar ulcer in the reception sites. Two patients had linear scar hyperplasia at the incision sites over the period of follow-up, due to the failure of adherence to regular scar prevention and treatment after wound healing. Appearances of the donor sites were good without functional impairment.Conclusion:The pedicled 5th intercostal perforator flap of the internal thoracic artery has a better clinical effect in reconstruction of the soft tissue defect after keloidectomy and/or cicatriciad ulcers excision caused by sternotomy and without a postoperative recurrence of a keloid and/or scar ulcer, with a good colour and appearance in the affected area and in a good appearance without a secondary functional impairment at the donor site.
