Intrathoracic Muscle Flaps: A 20-year Experience of 437 Consecutive Patients
Ziyad S. Hammoudeh, M.D., Amelia C. Van Handel, B.S., Arya A. Akhavan, B.S., Francis C. Nichols, III, M.D., Brian T. Carlsen, M.D., Steven L. Moran, M.D., Samir Mardini, M.D., PG Arnold, M.D.
Mayo Clinic, Rochester, MN, USA.
Large series examining intrathoracic muscle flaps (IMFs) are lacking in the literature. The purpose of this study was to analyze the morbidity/mortality of IMFs and create an algorithm for their use.
All patients undergoing IMFs from 1991 to 2010 were retrospectively-reviewed.
There were 437 patients (292 males, 145 females) who underwent 492 IMFs (354 serratus anterior, 54 latissimus, 36 intercostal, 32 pectoralis major, 7 omentum, 3 rectus abdominis, 6 other). Multiple IMFs were used in 44 patients (range 1-4 total flaps). Median age was 60-years-old (range 16-91). IMFs were used for infection in 264 patients (24.1% previously-irradiated) and prophylactically for bronchial coverage following lung resection in 173 patients (64.9% previously-irradiated). The rate of complications was significantly higher in the infected group (56.3%, n=147) vs. prophylactic group (23.3%, n=40) (p<0.0001). In-hospital mortality was significantly higher in the infected group (14%, n=37) vs. prophylactic group (5.2%, n=9) (p=0.005; odds-ratio 2.97). In-hospital mortality was also significantly higher in patients having multiple flaps vs. a single flap (20.5% vs. 9.4%) (p=0.028; odds-ratio 2.47). Median length-of-stay following IMF was 14-days (range 1-258) with median ICU length-of-stay of 4-days (range 0-258). Median follow-up for patients discharged was 9-months (range 0-274).
Use of IMFs in complex intrathoracic conditions can be lifesaving. However, patients still experience substantial morbidity and mortality. An algorithm is presented to help guide flap selection (Figure).
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