Flap course Day1 - Deltopectoral flap

Flap course Day1

Omdurman teaching hospital

Upper limb & anterior trunk

Deltopectoral flap

Deltopectoral Flap, was developed by Bakamjian as an axial-pattern skin flap, and its blood supply depends on perforating branches from the internal mammary artery. The main blood supply of the deltopectoral flap is provided by the second and third intercostal arteries. Deltoid portion is random.

 Indications

1. Carotid coverage after pharyngocutaneous fistula formation
2. for cervical and neck reconstructions
3. Hypopharyngeal reconstruction
4. Sternum reconstructions
5. Oral cavity & floor of the mouth
6. Paired Deltopectoral Flap was prescribed for lower lip reconstruction. 

Contraindications

1. For most cases, other flaps are a better choice.
2. Prior chest wall surgery or injury (eg, radical mastectomy, pacemaker)
3. Prior cardiac surgery with use of internal mammary artery for bypass

Consent Inclusions

1. Chest wall and neck scar
2. Possible need for skin grafting to shoulder
3. Bleeding, infection
4. Flap failure (distal necrosis possible)

 

To prevent injury to the perforators, flap elevation should remain lateral to a vertical line approximately 2 cm from the sternal border. The vessels provide an axial blood supply to the proximal two thirds of the flap; the remaining third is random in distribution. The elevation of this flap below the pectoralis fascia protects the subdermal network of vasculature for the random distribution. A delay technique may be valuable.

Interesting  Classification of sternal wounds: Pairolero and Arnold have based their classification of sternal wounds on timing of presentation of infection; this classification divides wounds into 3 categories.This classification system does not indicate the type of reconstruction necessary for management of each type of sternal wound. Type II and III wounds are typically referred to plastic surgeons for reconstruction.

• Type I: Type I wounds occur in the first few days postoperatively, contain early wound separation with or without sternal instability, and are characterized by serosanguineous drainage without cellulitis, osteomyelitis, or costochondritis.
• Type II: Type II wounds occur within the first few weeks and are characterized by drainage, cellulitis, mediastinal suppuration, and positive cultures. Type II wounds are characterized by fulminant mediastinitis.
• Type III: Type III wounds occur months to years after surgery and are characterized by the presence of chronic draining sinus tracts, localized cellulites, osteomyelitis, or retained foreign bodies. Mediastinitis is a rare complication of type III wounds.