About the fine art of dicovering the new
About the fine arts of discovering the new
Report on the “Convegno lginio Tansini e la sua eredità chirurgica“, Palazzo Centrale dell‘ Università, Pavia, Italy, March 29-31, 1996
E. Vaubel1, J. Hussmann- 1 Department of Plastic Surgery, Krankenhaus Zehlendorf-Behring, Girnpelsteig 3, D-14165 Berlin, Germany 2 Klinik für Plastische Chirurgie, BG-Universitätskliniken Bergmannsheil, Bürkle-de-Ia-Camp-Platz 1, D-44789 Bochum, Germany
The latissimus dorsi flap started its very successful course as the workhorse of plastic surgery 20 years ago, in 1976. In 1896, I OO years ago, Iginio Tansini described the latissìmus dorsi flap. The technique was well reknown before World War I. Shortly thereafter the flap was not utilized any more. After the end of World War II, most of the former literature was either destroyed or unavailable for various reasons) thus the latissimus dorsi flap had to be discovered a second time.
Neven Olivari published his studies on the use of the latissimus dorsi muscle in 1976. Several years later Patrick Maxwell published similar work. Thus, in 1996, two anniversaries were celebrated: the 1OOth anniversary of the paper by Iginio Tansini and the 20th anniversary of the re-discovery by Neven Olivari. Professor G. Boggio Robutti, Director of the Department of Plastic Surgery, and his coworker, Dr. Brambilla, or- 4] and provides an extremely versatile flap for recon struction of abdominal wall and chest wall defects.
A single rectus muscle pedicle flap harvested from its origin on the pubis and based on the superior epigastric pedicle can easily reach the sternal notch. Creation of a superiorly based island flap of further cephalad dissec tion of the superior epigastric pedicle by removal of rib and cartilage allows even greater cephalad flap move ment, however this is usually unnecessary
The sternal wound in our case presented some inter esting reconstructive challenges. First of all, when an an eurysm which widens the mediastinum is resected and replaced with a prosthetic graft a good deal of dead space is left behind. Fluid collects in this dead space and thus infection of the mediastinum and the prosthetic graft can occur.
When a prosthetic graft of the ascending aorta be comes infected, its removal and replacement is difficult, if not impossible. The mortality figures for the original prosthetic graft placement for an acute dissection of the ascending aorta has been variably reported as 3-30% [5, 6].
Mortality figures for replacement of an infected pros thetic graft approach l00%. The best course of action is to control the infection and leave the existing graft in place. It may never be possible to completely eliminate or cure the graft infection and lifetime antibiotics are ad vised . In order to achieve optimal control of infection tight tissue coverage with elimination of dead space and delivery of antibiotics to the surface of the aortic graft must be provided. These criteria were met by a superiorly based rectus abdominis muscle flap. The advantage of this technique is that the abdominal cavity is not opened adjacent to an infected mediasti num as is necessary when the omentum is used