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Früh- und Spätergebnisse nach Latissimus-dorsi-Lappenplastiken bei sternalen Wundheilungsstörungen und Wundinfektionen

dc.contributor.advisorFelmerer, Gunther PD Dr.
dc.contributor.authorKrahlisch, Joelle
dc.titleFrüh- und Spätergebnisse nach Latissimus-dorsi-Lappenplastiken bei sternalen Wundheilungsstörungen und Wundinfektionende
dc.title.translatedLatissimus Dorsi Flap in the Treatment of Thoracic Wall Defects After Medial Sternotomyde
dc.contributor.refereeFelmerer, Gunther PD Dr.
dc.description.abstractengBackground: This study aimed to describe the subjective and objective results of the latissimus dorsi muscle flap and propose it as a reconstructive option for postoperative thoracic defects.  Methods: A systematic search for cases with pedicle-based latissimus dorsi flaps performed after medial sternotomy was conducted, and all cases occurred between 2010 and August 2017. Preoperative, intraoperative, and postoperative factors were retrospectively analyzed and then the correlations between prognostic factors and outcomes of flap surgery were calculated. Furthermore, an evaluation of the subjective quality of life after flap surgery was performed using questionnaires.   Results: A total of 25 cases were identified (8 female and 17 male patients) with the mean age of 75.28 years (range, 55-88 years). The average survival rate was 39.63 ± 23.03 months. The proportion of patients with a survival rate of 1 year was 84.00% (21 patients), and the proportion of patientswith a 2-year survival ratewas 80.00% (20 patients). While 24% of all patients who had latissimus dorsi flap operations experienced no complications, 64% of them developed minor complications (non–life-threatening, Clavien-Dindo grades IIIIb) and 12% of them developed major complications (life-threatening, Clavien-Dindo grades IV-V). There was a significant correlation between the low survival rate and risk factors such as a positive history of smoking (P = .034), renal insufficiency (P = .022), metabolic syndrome (P = .004), and the presence of postoperative complications (P <.00002). No significant correlation was observed between the survival rate and obesity (P = .396), hyperlipoproteinemia (P = .684), arterial hypertonia (P = .0450), diabetes (P = .891), cardiovascular comorbidities (P = .794), the interval between sternotomy and latissimus flap surgery (P = .075), the duration of flap surgery (P = .207), sternal osteitis (P = .78), and intraoperative application of norepinephrine (P = .818). We identified metabolic syndrome (hazard ratio: 6.27), renal insufficiency (hazard ratio: 3.935), and the presence of postoperative complications (hazard ratio: 2.965) as high-risk prognostic factors. The subjective evaluations revealed positive reports from the patients with an average score of 1.86 ± 1.03 (1.0 =  very good; 5.0 =  poor).  Conclusions:  The majority of the patients with defects after median sternotomy were treated successfully with the latissimus dorsi flap. High survival rates, low rates of severe complications, and subjective scoring of improved life quality make this procedure relative safe and reliable. However, some prognostic risk factors limit the outcome, so these factors should be considered during surgical
dc.contributor.coRefereeBaraki, Hassina Prof. Dr.
dc.subject.engPlastic Surgeryde
dc.subject.engTreatment of Thoracic Wall Defectsde
dc.subject.engLatissimus Dorsi Flapde
dc.subject.engClavien and Dindo Classificationde
dc.subject.engReconstructive Option for postoperative Thoracic Defectsde
dc.subject.engPrognostic Factors and Outcomes of Flap Surgeryde
dc.affiliation.instituteMedizinische Fakultätde
dc.subject.gokfullMedizin (PPN619874732)de

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