%0 Journal Article
%T Reconstruction of an emergency thoracotomy wound with free rectus abdominis flap: Anatomic and radiologic basis for the surgical technique
%A Kaitlyn Gilman
%A Kyros Ipaktchi
%A Ernest E Moore
%A Carlton Barnett
%A Raffi Gurunluoglu
%J World Journal of Emergency Surgery
%D 2010
%I BioMed Central
%R 10.1186/1749-7922-5-12
%X The use of the emergency department thoracotomy (EDT) is invaluable in salvaging critically injured patients [1]. Patients with penetrating cardiac wounds associated with cardiac tamponade have the highest EDT success, while the overall survival rate of EDT is 7.4% [1].The postoperative infection rate of EDT is not reported in the literature and we have no previous event at Denver Health Medical Center over the past 33 years. We present a 50- year-old male patient with an infected chest wall wound following an emergent anterolateral thoracotomy. Preoperative planning and management of this rare wound complication is reviewed in this report.A 50-year-old alcoholic male with a history of schizophrenia presented in profound shock to the Denver Health Emergency Department with stab wounds to the left thorax. 1.5 liter of blood was aspirated with an emergent pericardiocentesis and the patient underwent resuscitative anterolateral thoracotomy in the ED. The emergency thoracotomy was performed in the standard fashion, with an incision made along the left fifth intercostal space extending across the sternum. After cardiac repair and hemostasis, the incision was closed primarily. At ten days post-operatively, the patient developed a thoracotomy wound infection that cultured positive for methicillin resistant staphylococcus aureus. Despite appropriate antibiotics, the infection necessitated radical debridement of involved bone (lower part of the sternum and rib), cartilage and soft tissue. Vacuum-assisted closure device (KCI, USA, San Antonio, TX) was placed after each debridement. The wound after two debridements measured approximately 20 กม 8 cm, and extended deep to the pericardium (Figure 1). Location of the EDT wound however precluded use of pectoralis major or latissimus dorsi muscle flaps due to the inadequate reach of these flaps. A CT angiography of the internal mammary vasculature was performed to explore the potential use of a superiorly based rectus abdominis muscl
%U http://www.wjes.org/content/5/1/12