B Schmidt-Rohlfing1, V Haas, M Vodopianov, O Kuhtin. 1. Klinik für Orthopädie und Unfallchirurgie, Siloah-St. Trudpert Klinkum, Wilferdinger Str. 67, 75179, Pforzheim, Deutschland, b.schmidt-rohlfing@siloah.de.
Abstract
OBJECTIVE: Closure of the wound defect with a pedicled pectoralis major muscular flap after successful surgical treatment of septic arthritis of the sternoclavicular joint (SCJ). INDICATIONS: Defect of the thoracic wall after septic arthritis of the SCJ. CONTRAINDICATIONS: Persistent infection of bony or soft tissue structures; persistent septicemia; persistent mediastinitis. SURGICAL TECHNIQUE: After successful treatment of the local infection and radical debridement of the wound, the incision is expanded parallel to the clavicle and to the sternum. The neurovascular pedicled pectoralis flap is mobilized and a resection of the muscular attachment at the humerus is performed. Finally, the flap is rotated at the pedicle and attached to the defect zone. POSTOPERATIVE MANAGEMENT: Anticoagulation with low molecular weight heparin and possibly aspirin (100 mg/day); short-term immobilization of the involved upper extremity. Avoidance of major weight bearing for a period of 6 weeks. RESULTS: Over a period of 4 years, 18 patients suffering from septic arthritis of the SCJ underwent surgical treatment. Of these, 9 patients were treated with pedicled muscular flap. In all patients, uneventful wound healing was observed with no further revision operations being required. The functional and optical results were satisfactory.
OBJECTIVE: Closure of the wound defect with a pedicled pectoralis major muscular flap after successful surgical treatment of septic arthritis of the sternoclavicular joint (SCJ). INDICATIONS: Defect of the thoracic wall after septic arthritis of the SCJ. CONTRAINDICATIONS: Persistent infection of bony or soft tissue structures; persistent septicemia; persistent mediastinitis. SURGICAL TECHNIQUE: After successful treatment of the local infection and radical debridement of the wound, the incision is expanded parallel to the clavicle and to the sternum. The neurovascular pedicled pectoralis flap is mobilized and a resection of the muscular attachment at the humerus is performed. Finally, the flap is rotated at the pedicle and attached to the defect zone. POSTOPERATIVE MANAGEMENT: Anticoagulation with low molecular weight heparin and possibly aspirin (100 mg/day); short-term immobilization of the involved upper extremity. Avoidance of major weight bearing for a period of 6 weeks. RESULTS: Over a period of 4 years, 18 patients suffering from septic arthritis of the SCJ underwent surgical treatment. Of these, 9 patients were treated with pedicled muscular flap. In all patients, uneventful wound healing was observed with no further revision operations being required. The functional and optical results were satisfactory.
Authors: Harold M Burkhart; Claude Deschamps; Mark S Allen; Francis C Nichols; Daniel L Miller; Peter C Pairolero Journal: J Thorac Cardiovasc Surg Date: 2003-04 Impact factor: 5.209