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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| Format: | Article |
| Language: | deu |
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German Medical Science GMS Publishing House
2017-06-01
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| Series: | GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW |
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| Online Access: | http://www.egms.de/static/en/journals/iprs/2017-6/iprs000111.shtml |
| _version_ | 1828315144349810688 |
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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 | DOAJ |
| 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 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. |
| first_indexed | 2024-04-13T16:56:01Z |
| format | Article |
| id | doaj.art-947132c4cfb84e8c935b5b66483b6193 |
| institution | Directory Open Access Journal |
| issn | 2193-8091 |
| language | deu |
| last_indexed | 2024-04-13T16:56:01Z |
| publishDate | 2017-06-01 |
| publisher | German Medical Science GMS Publishing House |
| record_format | Article |
| series | GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW |
| spelling | doaj.art-947132c4cfb84e8c935b5b66483b61932022-12-22T02:38:48ZdeuGerman Medical Science GMS Publishing HouseGMS Interdisciplinary Plastic and Reconstructive Surgery DGPW2193-80912017-06-016Doc0910.3205/iprs000111Anatomic study of the vascular perfusion of the sternum and its clinical relevance in deep sternal wound infectionSpindler, Nick0Kaatz, Florian1Feja, Christine2Etz, Christian3Mohr, Friedrich-Wilhelm4Bechmann, Ingo5Josten, Christoph6Langer, Stefan7Loeffler, Sabine8Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, GermanyInstitute of Anatomy, University of Leipzig, Leipzig, GermanyInstitute of Anatomy, University of Leipzig, Leipzig, GermanyDepartment of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Leipzig, GermanyDepartment of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Leipzig, GermanyInstitute of Anatomy, University of Leipzig, Leipzig, GermanyDepartment of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, GermanyDepartment of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, GermanyInstitute of Anatomy, University of Leipzig, Leipzig, GermanyIntroduction: 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 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.http://www.egms.de/static/en/journals/iprs/2017-6/iprs000111.shtmldeep sternal wound infection (DSWI)internal thoracic artery (ITA)vascular system of the sternum |
| spellingShingle | 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 GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW deep sternal wound infection (DSWI) internal thoracic artery (ITA) vascular system of the sternum |
| 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 | deep sternal wound infection (DSWI) internal thoracic artery (ITA) vascular system of the sternum |
| url | http://www.egms.de/static/en/journals/iprs/2017-6/iprs000111.shtml |
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