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Cardiothoracic Surgery |

Chest-Wall Necrosis After Aortic Aneurysm Repair

José González García, MD; Sebastian Peñafiel, MD; Eugenia Libreros Niño, MD; Diana Baquero Velandia, MD; Carlos Jordá Aragón, MD
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La Fe University Hospital, Valencia, Spain


Chest. 2014;145(3_MeetingAbstracts):32A. doi:10.1378/chest.1824932
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Abstract

SESSION TITLE: Surgery Case Report Posters II

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Chest-wall osteonecrosis is a rare surgical complication. It is mostly seen after radiotherapy. There are several options for its repair, but we always must assure first there is no infection, that can compromise the placement of prosthetic materials. And in that case, we should avoid the use of posthetic materials and look for different options. Vaacum-assisted therapy (VAC) can be a very usefull tool.

CASE PRESENTATION: A 65-year-old man with a diagnosed thoraco-abdominal aortic-aneurysm, DeBakey IIIB aortic-dissection, was operated doing a thoraco-phreno-laparotomy. A 28mm prosthesis was used to replace the aneurysm, and because of bounteous bleeding some intercostal-arteries had to be closed. The patient developed chest-wall necrosis within two weeks, and led to infection by Enterobacter Cloacae and later sepsis. Continuous debriding of necrotic-tissue was necessary and we decided to use complementary VAC therapy. After 3 months the wound was cleaned up and could be closed. The chest-wall defect was unexpectedly reduced enough to perform a simple thoraco-myoplasty with Latissimus dorsi and serratus anterior muscles, that were directly sewed to rectus abdominalis. Full recovery was achieved after 4 months.

DISCUSSION: A good option for chest-wall reconstruction is to use alone myocutaneous flaps. It gives enough stability to the chest-wall and involves less infectious risk than when using prosthetic materials. VAC therapy is useful to clean the wound in the case of infection and also can reduce the size of the defect.

CONCLUSIONS: Simple closure was possible due to timely indication of VAC therapy, with close and continuous follow-up of the patient. Nevertheless we are used or not to use prosthetic materials in chest wall reconstruction, or we prefer any of the different surgical techniques available, the most important thing is to think carefully on each step we take in the treatment of our patients. We also should always remember about team work. That will always help us to provide our patients the best options available in our means.

Reference #1: O’Connor J, Kells A, Henry S, Scalea T. Vacuum-Assisted Closure for the Treatment of Complex Chest Wounds. The Annals of Thoracic Surgery. April 2005;Vol 79;Issue 4;1196-1200.

Reference #2: M Makboul, M Ayyad. Is myocutaneous flap alone sufficient for reconstruction of chest wall osteoradionecrosis? Interactive CardioVascular and Thoracic Surgery 2012;15;447-451. doi:10.1093/icvts/ivs146

DISCLOSURE: The following authors have nothing to disclose: José González García, Sebastian Peñafiel, Eugenia Libreros Niño, Diana Baquero Velandia, Carlos Jordá Aragón

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