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

Yim,  Ji Hong; Eom,  Jin Sup; Kim,  Deok Yeol

doi:2014.23.2.89

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Archives of Hand and Microsurgery 2014;23(2):89-92.
Published online November 30, 2014.
DOI: https://doi.org/10.15596/ARMS.2014.23.2.89

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

Ji Hong Yim, Jin Sup Eom<sup>*</sup>, Deok Yeol Kim<sup>1</sup>

¹Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. jinsupp@amc.seoul.kr
²Department of Plastic and Reconstructive Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.

Received: 1 October 2014 • Revised: 4 November 2014 • Accepted: 4 November 2014

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.

Key Words: Chest wall, Transverse rectus abdominis musculocutaneous flap

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