Arch Reconstr Microsurg.  2014 Nov;23(2):89-92. 10.15596/ARMS.2014.23.2.89.

Chest Wall Reconstruction with a Transverse Rectus Abdominis Musculocutaneous Flap in an Extremely Oversized Heart Transplantation

• Yim JH
• Eom JS
• Kim DY

• KMID: 1917845
• DOI: http://doi.org/10.15596/ARMS.2014.23.2.89

Abstract

An 8-year-old girl diagnosed with dilated cardiomyopathy and Russell-Silver syndrome was admitted to our pediatric intensive care unit due to low cardiac output and multiple-organ dysfunction. The patient was placed on the heart transplant waiting list and extracorporeal membrane oxygenation was performed as a bridge to transplantation. After 17 days, heart transplantation was performed. The donor was a 46-year-old female (weight, 50 kg; height, 150 cm). The donor:recipient weight ratio was 3.37:1. Because the dimension and volume of the recipient's thoracic cage were insufficient, the sternum could not be closed. Nine days after transplantation, the patient underwent delayed sternal closure. To obtain adequate space, we left the sternum 4.5 cm apart from each margin using four transverse titanium plates. A transverse rectus abdominis musculocutaneous flap was chosen to cover the wound. Due to the shortage of donors, a size-mismatched pediatric heart transplantation is sometimes unavoidable. Closure of the opened sternum of a transplant recipient can be challenging. Sternal reconstruction after an extremely oversized heart transplantation with transverse titanium plate fixation and a musculocutaneous flap can effectively achieve sternal closure and stability.

Keyword

Chest wall; Transverse rectus abdominis musculocutaneous flap

MeSH Terms

Cardiac Output, Low
Cardiomyopathy, Dilated
Child
Extracorporeal Membrane Oxygenation
Female
Heart
Heart Transplantation*
Humans
Intensive Care Units
Middle Aged
Myocutaneous Flap*
Rectus Abdominis*
Silver-Russell Syndrome
Sternum
Thoracic Wall*
Tissue Donors
Titanium
Transplantation
Waiting Lists
Wounds and Injuries
Titanium