Application of the pectoralis major muscle for chest wall reconsruction after infectious-inflammatory diseases

• Mikhail A. Medvedchikov-Ardiia
• Korymasov E.A.
• Benian A.S.
• Sadovskaya Yu.E.
• Shatilova S.V.

Abstract

Chest wall defects in infectious and inflammatory diseases, as a rule, require plastic reconstruction. The main plastic material is the pectoralis major muscle.

Material and methods. The result of treatment of 88 patients with chest wall defects of infectious and inflammatory etiology, who underwent various types of pectoralis major plasty at the reconstructive stage, is presented. The main causes of osteomyelitis of the sternum and ribs were: surgical interventions on the organs of the chest cavity, trauma, septicemia, radiation exposure in the combined treatment of breast cancer. All patients underwent computed tomography of the chest. Patients with grafting with full-thickness flaps in the preoperative and postoperative period underwent Doppler ultrasound of the arteries supplying the flap.

Results. There were no lethal outcomes in patients with muscle plasty with pectoralis major muscle flaps. The average area of the eliminated defect was 78±3.4 cm² (from 38 to 110 cm²). Doppler ultrasound revealed no statistically significant differences in linear and volumetric velocity along the thoracic branch of the thoracoacromial artery and along the perforating branch of the internal thoracic artery. There were no statistically significant differences in these rates on the 1st day after surgery compared with preoperative indicators. After 1 month, these indicators did not statistically significantly differ from the baseline. There were no intraoperative complications in the patients. In 1 case, total necrosis of the flap was noted, in 2 patients a hematoma was detected, and in 3 patients, a seroma in the surgical area. In the long-term period, 2 patients had a recurrence of the infectious process – perichondritis of the ribs.

Conclusion. Each type of pectoralis major muscle flap has its own indications for plastic reconstruction of a chest wall defect. Knowledge of the anatomy and blood supply of the pectoralis major muscle allows the surgeon to use it reasonably and effectively in the treatment of patients with infectious and inflammatory diseases of the chest wall.

Keywords:osteomyelitis of the sternum; osteomyelitis of the ribs; muscle flap; pectoralis major muscle flap; chest wall defect

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