METHOD OF PLASTY OF A CHEST WALL DEFECT WITH A FULL-THICKNESS SKIN-SUBCUTANEOUS-FASCIO-MUSCULAR FLAP ON THE PERFORATING BRANCH OF THE INTERNAL THORACIC ARTERY Russian patent published in 2023 - IPC A61B17/56 A61B8/06 

FIELD: medicine, thoracic surgery.

SUBSTANCE: preoperative assessment of the perforant branches of both internal mammary arteries using color duplex mapping is conducted. The choice of the side of the planned fence of the full-layer skin-subcutaneous-fascial-muscular flap is carried out. The debridement of the chest wall wound is performed with the removal of infected and necrotically altered edges of the sternum and costal cartilages. In the projection of the proposed perforant vessel from the lateral edge of the surgical wound in the lateral direction with a dissection of the skin, subcutaneous tissue and pectoralis major muscle, a full-thickness skin-subcutaneous-fascio-muscular flap 10 cm long and 4 cm wide is formed. The flap receives arterial blood supply from the perforating branch internal thoracic artery, departing from the specified vessel at the upper edge of the cartilaginous part of the rib directly at the place of its attachment to the sternum. A full-thickness skin-subcutaneous-fascio-muscular flap is mobilized along the entire perimeter, leaving the fixation site in the area of the passage of the perforating vessel only. The mobilized full-thickness skin-subcutaneous-fascio-muscular flap is moved into the defect of the chest wall, rotating it by 90° relative to the perforating branch. Then two perforated drainage tubes are installed: one in the area of the taken full-thickness skin-subcutaneous-fascio-muscular flap, the second — in the area of the chest wall defect under the displaced full-thickness flap; drainage tubes are removed through separate incisions on the skin. The drains are connected to a Redon-type vacuum. The wound in the sampling area of the full-layer skin-subcutaneous-fascio-muscular flap is sutured in layers: with a continuous 3-0 absorbable thread, the edges of the pectoralis major muscle are brought together with interrupted sutures at the level of the superficial chest fascia, the skin is sutured with a stapler. The displaced full-thickness skin-subcutaneous-fascio-muscular flap is fixed with nodular absorbable ligatures at the level of subcutaneous tissue with the edges of the chest wall wound. The skin edges are brought together and fixed with a skin stapler.

EFFECT: method makes it possible to eliminate a deep residual cavity of a chest wall defect after resection of a part of the body of the sternum, promotes wound closure without tension on the skin edges, creates conditions for wound healing by primary intention with a good cosmetic effect.

1 cl, 2 ex