COMBINED USE OF PEDICULATED MUSCLE FLAP AND Z-PLASTY IN THE CLOSURE OF STERNAL WOUNDS IN HIGH-RISK PATIENTS

BEKERECİOĞLU, MEHMET; bilgen, fatma; Ural, Alper

COMBINED USE OF PEDICULATED MUSCLE FLAP AND Z-PLASTY IN THE CLOSURE OF STERNAL WOUNDS IN HIGH-RISK PATIENTS

Fatma BİLGEN, (Kahramanmaraş Sutcu Imam University School of medicine. Plastic, Reconstructive and Aesthetic Surgery Departmant, Kahramanmaraş, Türkiye)

ALPER URAL, (Kahramanmaraş Sutcu Imam University School of medicine. Plastic, Reconstructive and Aesthetic Surgery Departmant, Kahramanmaraş, Türkiye)

Mehmet BEKERECİOĞLU (Kahramanmaraş Sutcu Imam University School of medicine. Plastic, Reconstructive and Aesthetic Surgery Departmant, Kahramanmaraş, Türkiye)

Namık Kemal Tıp Dergisi

1 0

Yıl: 2018 Cilt: 6 Sayı: 1 Sayfa Aralığı: 15 - 20 Metin Dili: İngilizce İndeks Tarihi: 17-10-2019

COMBINED USE OF PEDICULATED MUSCLE FLAP AND Z-PLASTY IN THE CLOSURE OF STERNAL WOUNDS IN HIGH-RISK PATIENTS

Öz:

Objective: Since deep sternal wound infections following sternotomy isa life-threatening complication, optimal management of sternal woundsstill of vital importance.This study presents our 10-year experience with the use of pediculatedmuscle flaps and multiple Z-plasty techniques in reconstruction andtension-free closure of deep sternal wound and skin defects.Material and Method: 14 patients with deep sternal wound infectionreferred to our clinic between 2006 and 2016 for the closure of theirdefects included in our study. Following aggressive debridement, allpatients underwent closure of mediastinal defect using pediculatedmuscle flaps, whereas primary skin repair was performed in sevenpatients and another seven patients required multiple Z-plasties due tohigh skin tension.Results: The tension-free closure was performed in all patients. None ofthe patients developed muscle or skin flap necrosis. Of a total of threepatients with postoperative complications, two of them developedseroma and one patient developed a hematoma. At a mean follow-upperiod of five years recovery was achieved with acceptable wound scarin patients who underwent repair with multiple Z-plasty techniques,Conclusion: Aggressive therapy with muscle flap reconstruction servesto reduce morbidity and mortality caused by sternal wound infection,whereas successful use of multiple Z-plasty techniques for skin closureallows the surgeon to perform tension-free closure and reduces the riskof skin necrosis, dehiscence and infections.

Anahtar Kelime:

Öz:

Amaç: Sternotomiyi takiben derin sternal yara enfeksiyonu hayati tehlike oluşturan bir komplikasyon olduğundan, sternal yaranın optimum yönetimi halen büyük önem taşımaktadır. Bu çalışmada, derin sternaldefekt ve cilt defektinde, rekonstrüksiyon ve gergin olmayan kapama elde etmek için pediküllü kas fleplerive çoklu zplasti tekniğininkullanımı ile ilgili 10 yıllık deneyimlerimiz sunulmaktadır. Materyal ve Metot: 2006-2016 yılları arasında derin sternal yara enfeksiyonu olan 14 hasta defekt kapatılması için kliniğimize sevk edildi. Tüm hastalarda agresif debridmansonrası mediastinaldefekti kapama pediküllü kas flepleri ile, deri kapanması ise birden fazla z-plasti kullanılarak yapıldı. Bulgular: Bütün hastalarda gergin olmayan bir defekt kapatılması sağlandı. Hiçbir kas ve deri flep nekrozu oluşmadı. Toplam 3 hastanın ikisinde seroma ve 1 hastada hemotom gibi postoperatif komplikasyonlar yaşadı. Ortalama 5 yıllık izlem (6 ay- 8 yıl) süresi sonunda tüm hastalarda kabul edilebilir yara izleriyle tam düzelme görüldü. Sonuç: Kas flebi rekonstrüksiyonu ile agresif tedavi, sternal yara enfeksiyonunun morbidite ve mortalitesini azaltmaya yardımcı olurken, cildin kapanması için çoklu z- plasti prosedürünün başarılı bir Ģekilde kullanılması, cerrahın minimal bir skarlagergin olmayan bir kapama elde etmesini ve ciltte nekroz, yara ayrıĢmasıve enfeksiyon riskini azaltmaktadır.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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APA	bilgen f, Ural A, BEKERECİOĞLU M (2018). COMBINED USE OF PEDICULATED MUSCLE FLAP AND Z-PLASTY IN THE CLOSURE OF STERNAL WOUNDS IN HIGH-RISK PATIENTS. , 15 - 20.
Chicago	bilgen fatma,Ural Alper,BEKERECİOĞLU MEHMET COMBINED USE OF PEDICULATED MUSCLE FLAP AND Z-PLASTY IN THE CLOSURE OF STERNAL WOUNDS IN HIGH-RISK PATIENTS. (2018): 15 - 20.
MLA	bilgen fatma,Ural Alper,BEKERECİOĞLU MEHMET COMBINED USE OF PEDICULATED MUSCLE FLAP AND Z-PLASTY IN THE CLOSURE OF STERNAL WOUNDS IN HIGH-RISK PATIENTS. , 2018, ss.15 - 20.
AMA	bilgen f,Ural A,BEKERECİOĞLU M COMBINED USE OF PEDICULATED MUSCLE FLAP AND Z-PLASTY IN THE CLOSURE OF STERNAL WOUNDS IN HIGH-RISK PATIENTS. . 2018; 15 - 20.
Vancouver	bilgen f,Ural A,BEKERECİOĞLU M COMBINED USE OF PEDICULATED MUSCLE FLAP AND Z-PLASTY IN THE CLOSURE OF STERNAL WOUNDS IN HIGH-RISK PATIENTS. . 2018; 15 - 20.
IEEE	bilgen f,Ural A,BEKERECİOĞLU M "COMBINED USE OF PEDICULATED MUSCLE FLAP AND Z-PLASTY IN THE CLOSURE OF STERNAL WOUNDS IN HIGH-RISK PATIENTS." , ss.15 - 20, 2018.
ISNAD	bilgen, fatma vd. "COMBINED USE OF PEDICULATED MUSCLE FLAP AND Z-PLASTY IN THE CLOSURE OF STERNAL WOUNDS IN HIGH-RISK PATIENTS". (2018), 15-20.

APA	bilgen f, Ural A, BEKERECİOĞLU M (2018). COMBINED USE OF PEDICULATED MUSCLE FLAP AND Z-PLASTY IN THE CLOSURE OF STERNAL WOUNDS IN HIGH-RISK PATIENTS. Namık Kemal Tıp Dergisi, 6(1), 15 - 20.
Chicago	bilgen fatma,Ural Alper,BEKERECİOĞLU MEHMET COMBINED USE OF PEDICULATED MUSCLE FLAP AND Z-PLASTY IN THE CLOSURE OF STERNAL WOUNDS IN HIGH-RISK PATIENTS. Namık Kemal Tıp Dergisi 6, no.1 (2018): 15 - 20.
MLA	bilgen fatma,Ural Alper,BEKERECİOĞLU MEHMET COMBINED USE OF PEDICULATED MUSCLE FLAP AND Z-PLASTY IN THE CLOSURE OF STERNAL WOUNDS IN HIGH-RISK PATIENTS. Namık Kemal Tıp Dergisi, vol.6, no.1, 2018, ss.15 - 20.
AMA	bilgen f,Ural A,BEKERECİOĞLU M COMBINED USE OF PEDICULATED MUSCLE FLAP AND Z-PLASTY IN THE CLOSURE OF STERNAL WOUNDS IN HIGH-RISK PATIENTS. Namık Kemal Tıp Dergisi. 2018; 6(1): 15 - 20.
Vancouver	bilgen f,Ural A,BEKERECİOĞLU M COMBINED USE OF PEDICULATED MUSCLE FLAP AND Z-PLASTY IN THE CLOSURE OF STERNAL WOUNDS IN HIGH-RISK PATIENTS. Namık Kemal Tıp Dergisi. 2018; 6(1): 15 - 20.
IEEE	bilgen f,Ural A,BEKERECİOĞLU M "COMBINED USE OF PEDICULATED MUSCLE FLAP AND Z-PLASTY IN THE CLOSURE OF STERNAL WOUNDS IN HIGH-RISK PATIENTS." Namık Kemal Tıp Dergisi, 6, ss.15 - 20, 2018.
ISNAD	bilgen, fatma vd. "COMBINED USE OF PEDICULATED MUSCLE FLAP AND Z-PLASTY IN THE CLOSURE OF STERNAL WOUNDS IN HIGH-RISK PATIENTS". Namık Kemal Tıp Dergisi 6/1 (2018), 15-20.