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Y-shaped Muscular Wrapping Technique Avoiding Re-infection of a Replaced Aortic Graft: A Cadaveric Study

Authors :
Itaru Tsuge, MD, PhD
Susumu Saito, MD, PhD
Masako Kataoka, MD, PhD
Hiroki Yamanaka, MD, PhD
Motoki Katsube, MD, PhD
Michiharu Sakamoto, MD, PhD
Naoki Morimoto, MD, PhD
Source :
Plastic and Reconstructive Surgery, Global Open, Vol 9, Iss 6, p e3626 (2021)
Publication Year :
2021
Publisher :
Wolters Kluwer, 2021.

Abstract

Summary:. Replacing an infected prosthetic thoracic aorta graft carries a high re-infection risk. We previously reported two clinical cases successfully treated with a new muscular wrapping technique: latissimus dorsi (LD) muscle flap with a distally based serratus anterior (SA) extension; however, a cadaveric study to prove the regular existence of the distal attachment area was lacking. We tried to establish an appropriate way of elevating the combined muscle flap safely. All of the cadavers were preserved using the Thiel embalming technique to retain flexibility. We checked for the existence of the distal attachment area between the LD and SA. Combined muscle flaps were elevated proximally while identifying the thoracodorsal artery, including the LD and SA branches. After the SA branch was ligated and cut, the SA muscle was manually peeled from the LD muscle with only the distal tight attachment area remaining. Contrast-enhanced computed tomography was performed using a multislice computed tomography system. Six human cadavers (three men, three women: 91 years old, on average) were examined. All six LD and SA combined muscle flaps showed a distal tight attachment area at the level from the seventh rib to the ninth rib. The tip of the SA muscle easily reached the sternum. Contrast-enhanced computed tomography failed to reconfirm the distal vascular flow from the LD to the reverse SA muscle, which we had visualized in a clinical case. We demonstrated the anatomical reliability of the new Y-shaped muscular flaps, which are suitable for preventing re-infection of aortic graft replacement.

Subjects

Subjects :
Surgery
RD1-811

Details

Language :
English
ISSN :
21697574 and 00000000
Volume :
9
Issue :
6
Database :
Directory of Open Access Journals
Journal :
Plastic and Reconstructive Surgery, Global Open
Publication Type :
Academic Journal
Accession number :
edsdoj.3730c99ab250410786ad26ac5c1fee58
Document Type :
article
Full Text :
https://doi.org/10.1097/GOX.0000000000003626