无胸壁缺损的心外胸骨旁小切口的可行性研究

Minimally invasive parasternal approach without postoperative chest wall defect: a feasibility study

目的研究以带蒂复合组织瓣修复胸骨旁小切口术后胸壁缺损的可行性。方法观察尸体前胸壁深层结构的血供 规律，测量胸骨外侧缘与胸廊内动脉之间的距离，并在此基础之上设计出以胸阔内动脉为蒂的肋软骨助间肌瓣。结果 前胸壁深层各结构均由胸廓内动脉及其分支供血，胸廊内动脉里胸骨外侧缘的距离为１ｃｍ左右。紧挨胸骨外侧缘切开 肋软骨，可以避免胸廓内动脉的损伤。以该动脉为帮，可以保证数种肋软骨肋间肌瓣有良好的血供。结论用以胸廊内动 脉为蒂的肋软骨助间肌瓣修复心脏外科术后的胸壁缺损具有良好的可行性。

Objective To study the feasibility of the application of pedicled flap in repairing postoperative chest wall defect resulted from parasternal surgical incision. Method The study of blood Ssupply of the deeper layers of the chest wall was conducted in 10 cadavers and the distance between the lateral edge of the sternum and the internal thoracic artery in every intercostal level were measured. Based on this study, several complicated tissue naps were devised using the internal thoracic artery as pedicle. Results The internal thoracic artery was the main nutrient artery for the deeper layers of the anterior chest wall, and the distance between the sternum and the internal thoracic artery was about 1 cm, which was wide enough for the incision between these two structures The internal thoracic artery could be used as a pedicle in various tissue flaps to repair the chest wall defect after parasternal thoracotomy Conclusion It is feasible to use the internal thoracic artery as a pedicle for the tissue flap to repair the defect after parasternal thoracotomy