Supercharged Rectus Abdominis Flap Combined with Pedicled Omental Flap for Complex Chest Wall Reconstruction
Year: 2025
Type: article
Study design: Case Report
Abstract: IntroductionMediastinitis and sternal osteomyelitis are significant complications after cardiovascular surgery.In severe cases, large defects often develop after debridement for sternal osteomyelitis, and a rectus abdominis flap is often used to cover the skin defect 1) .When the skin defect extends superiorly, the flap needed to close the defect must be large, which may raise concerns of partial or total flap necrosis.Supercharge and superdrainage are often established to maintain blood flow and prevent flap necrosis 2) .However, finding appropriate donor vessels for supercharge or superdrainage can be challenging.We herein report a case of mediastinitis and sternal osteomyelitis in which a rectus abdominis myocutaneous flap and a greater omental flap were used in reconstruction.The pedicled omentum provided the donor vessels needed to achieve supercharge and superdrainage. Case presentationA mass appeared in the thoracic region of a 78-year-old man.Mediastinitis was diagnosed, and the patient was admitted to our hospital on an emergency basis (Fig. 1).He had a history of cerebral infarction and had undergone reconstruction of the aortic arch for a thoracic aortic aneurysm at 66 years old, stent graft insertion for a descending aortic aneurysm at 70 years old, and reconstruction with left pectoralis major muscle flap for a sternal osteomyelitis at 74 years old.Three months before his visit to our hospital, he had undergone stent graft insertion for an abdominal aortic aneurysm.Preoperative computed tomography revealed that the abscess was located deep in the anterior mediastinum and was adjacent to the artificial graft (Fig. 2).Based on these imaging findings, we diagnosed the infection as being caused by graft contamination as well as osteomyelitis of the residual sternum.Enterococcus faecalis was identified in the wound culture.
Authors: Kotone Kato, Junpei Saito, Shoichi Ishikawa, Tomoya Sato, Shigeru Ichioka
Institution: Saitama Medical University
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4414599050