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Anatomic study of the vascular perfusion of the sternum and its clinical relevance in deep sternal wound infection

Introduction: Deep sternal wound infections (DSWI) are a rare but devastating complication after median sternotomy. Minor perfusion in bone and soft tissue, especially after recruiting the internal mammary artery for bypass supports the development of wound infection and nonunion of the sternal bone...

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Autores principales: Spindler, Nick, Kaatz, Florian, Feja, Christine, Etz, Christian, Mohr, Friedrich-Wilhelm, Bechmann, Ingo, Josten, Christoph, Langer, Stefan, Loeffler, Sabine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: German Medical Science GMS Publishing House 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461580/
https://www.ncbi.nlm.nih.gov/pubmed/28611938
http://dx.doi.org/10.3205/iprs000111
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author Spindler, Nick
Kaatz, Florian
Feja, Christine
Etz, Christian
Mohr, Friedrich-Wilhelm
Bechmann, Ingo
Josten, Christoph
Langer, Stefan
Loeffler, Sabine
author_facet Spindler, Nick
Kaatz, Florian
Feja, Christine
Etz, Christian
Mohr, Friedrich-Wilhelm
Bechmann, Ingo
Josten, Christoph
Langer, Stefan
Loeffler, Sabine
author_sort Spindler, Nick
collection PubMed
description Introduction: Deep sternal wound infections (DSWI) are a rare but devastating complication after median sternotomy. Minor perfusion in bone and soft tissue, especially after recruiting the internal mammary artery for bypass supports the development of wound infection and nonunion of the sternal bone. The aim of the study was the macroscopic and radiological presentation of the vascular system supplying the sternum, in particular the compensating blood supply routes in the event that the internal mammary artery is no longer available after use as a bypass vessel. Method: This anatomic study was carried out on the anterior chest wall of 7 specimens. The thorax plates of 7 specimens were analyzed macroscopically after microsurgical preparation. Different anatomic preparations were produced using different contrast or form-giving substances. Radiological analysis and three-dimensional reconstructions were performed to show alternative, collateral sternal vessel perfusion under estimation of the loss of the internal thoracic artery due to a bypass. Results: The length of the ITA (internal thoracic artery), measured from the beginning of the first rib to the division into the superior epigastric artery and musculophrenic artery, was an average of 16.3 cm. On average, 18.5 branches were delivered from each artery, 10 medially to the sternum supply, and 8 to the intercostal muscle. Conclusion: Our analysis gives an overview of the macroanatomic vessel system supplying the sternal bone, describing especially a common trunk deriving from the ITA and supplying multiple branches and playing an important role in building a collateral circulation of the sternum. For better evaluation, in vivo CT analysis with contrast media should be performed in patients prior to the operation and directly after the use of the double ITA to demonstrate the change in perfusion of the sternum. In the future, preconditioning of the sternum by coiling the deriving branches could become an option, although patient selection has to be improved and further analysis of the topic performed.
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spelling pubmed-54615802017-06-13 Anatomic study of the vascular perfusion of the sternum and its clinical relevance in deep sternal wound infection Spindler, Nick Kaatz, Florian Feja, Christine Etz, Christian Mohr, Friedrich-Wilhelm Bechmann, Ingo Josten, Christoph Langer, Stefan Loeffler, Sabine GMS Interdiscip Plast Reconstr Surg DGPW Article Introduction: Deep sternal wound infections (DSWI) are a rare but devastating complication after median sternotomy. Minor perfusion in bone and soft tissue, especially after recruiting the internal mammary artery for bypass supports the development of wound infection and nonunion of the sternal bone. The aim of the study was the macroscopic and radiological presentation of the vascular system supplying the sternum, in particular the compensating blood supply routes in the event that the internal mammary artery is no longer available after use as a bypass vessel. Method: This anatomic study was carried out on the anterior chest wall of 7 specimens. The thorax plates of 7 specimens were analyzed macroscopically after microsurgical preparation. Different anatomic preparations were produced using different contrast or form-giving substances. Radiological analysis and three-dimensional reconstructions were performed to show alternative, collateral sternal vessel perfusion under estimation of the loss of the internal thoracic artery due to a bypass. Results: The length of the ITA (internal thoracic artery), measured from the beginning of the first rib to the division into the superior epigastric artery and musculophrenic artery, was an average of 16.3 cm. On average, 18.5 branches were delivered from each artery, 10 medially to the sternum supply, and 8 to the intercostal muscle. Conclusion: Our analysis gives an overview of the macroanatomic vessel system supplying the sternal bone, describing especially a common trunk deriving from the ITA and supplying multiple branches and playing an important role in building a collateral circulation of the sternum. For better evaluation, in vivo CT analysis with contrast media should be performed in patients prior to the operation and directly after the use of the double ITA to demonstrate the change in perfusion of the sternum. In the future, preconditioning of the sternum by coiling the deriving branches could become an option, although patient selection has to be improved and further analysis of the topic performed. German Medical Science GMS Publishing House 2017-06-06 /pmc/articles/PMC5461580/ /pubmed/28611938 http://dx.doi.org/10.3205/iprs000111 Text en Copyright © 2017 Spindler et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.
spellingShingle Article
Spindler, Nick
Kaatz, Florian
Feja, Christine
Etz, Christian
Mohr, Friedrich-Wilhelm
Bechmann, Ingo
Josten, Christoph
Langer, Stefan
Loeffler, Sabine
Anatomic study of the vascular perfusion of the sternum and its clinical relevance in deep sternal wound infection
title Anatomic study of the vascular perfusion of the sternum and its clinical relevance in deep sternal wound infection
title_full Anatomic study of the vascular perfusion of the sternum and its clinical relevance in deep sternal wound infection
title_fullStr Anatomic study of the vascular perfusion of the sternum and its clinical relevance in deep sternal wound infection
title_full_unstemmed Anatomic study of the vascular perfusion of the sternum and its clinical relevance in deep sternal wound infection
title_short Anatomic study of the vascular perfusion of the sternum and its clinical relevance in deep sternal wound infection
title_sort anatomic study of the vascular perfusion of the sternum and its clinical relevance in deep sternal wound infection
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461580/
https://www.ncbi.nlm.nih.gov/pubmed/28611938
http://dx.doi.org/10.3205/iprs000111
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