ABSTRACT
Pectus excavatum or funnel chest is one of the most common congenital chest wall deformities. Surgical correction should be considered for all patients with moderate to severe deformities because of the significant cosmetic and psychological improvement, subjective increase in exercise tolerance, documented changes in the cardiac and respiratory status, and prevention of the development of scoliosis after surgical intervention in these patients. The sternal turn over procedure with preserved internal mammary vessels and rectus abdominis muscle pedicles for the corrective repair of severe pectus excavatum, involves resection of the deformed thoracic wall, sternum and ribs, preserving an attachment of the rectus abdominis muscle,and a vascular pedicle of the internal mammary vessel. A short segment resection above the ipsilateralcostal cartilage is mandatory to allow reposition of the vascular pedicle onto the presternal surface after turn over of the sternum. Multiple corrective osteotomy and costoplasty must be completed before refixing the sternum and ribs. The modified sternal turn over procedure restores the sternal blood supply and should be applied to the severe form of pectus excavatum which needs extensive and multiple bony resection. The procedure has been applied to a boy and a girl aged 5 years. At a three year follow up, the results obtained are excellent.
ABSTRACT
The aim of the present study is to get anatomical information of internal mammary vessels(IMV), which is usually used for recipient vessels in the breast reconstruction. The past anatomical studies of these vessels had been done primarily with cadavers in the Occidentals. Because there is no report for the anatomical study of these vessels and also the cadaver study is pretty limited in this country, we studied the anatomical pattern of IMV in Koreans by using two dimensional reconstructive computed tomography (2DCT) and Doppler ultrasound (US). The branching patterns, level of bifurcation, size of IMV and the distance from the sternal edge to the IMV were measured. This study was performed in 30 breast cancer patients from May 1999 to May 2000. One artery and one vein on both sides(type I) was the most common type that were observed in 22 of 30 patients(73%). The diameter of the internal mammary artery(average 2.1 mm) was constant but that of the internal mammary vein had a wide variation(ranged 0.8 to 4.8 mm). The distance from sternum to IMV gradually got narrower as it went caudally. In three cases the size of vein was not enough for anastomosis, but the bifurcation point may be used for anastomosis due to the wider point. Compared with the result of Caucasian, the incidence of bifurcation of internal mammary vein was lower and the level of bifurcation was higher. The result showed that the most successful level of anastomosis was the 3rd intercostal space in Korean due to shorter chest. The combination of 2DCT and US provided us with useful preoperative information as well as general anatomical data in Korean.
Subject(s)
Female , Humans , Arteries , Breast Neoplasms , Cadaver , Incidence , Mammaplasty , Sternum , Thorax , Ultrasonography , VeinsABSTRACT
The aim of the present study is to get anatomical information of internal mammary vessels(IMV), which is usually used for recipient vessels in the breast reconstruction. The past anatomical studies of these vessels had been done primarily with cadavers in the Occidentals. Because there is no report for the anatomical study of these vessels and also the cadaver study is pretty limited in this country, we studied the anatomical pattern of IMV in Koreans by using two dimensional reconstructive computed tomography (2DCT) and Doppler ultrasound (US). The branching patterns, level of bifurcation, size of IMV and the distance from the sternal edge to the IMV were measured. This study was performed in 30 breast cancer patients from May 1999 to May 2000. One artery and one vein on both sides(type I) was the most common type that were observed in 22 of 30 patients(73%). The diameter of the internal mammary artery(average 2.1 mm) was constant but that of the internal mammary vein had a wide variation(ranged 0.8 to 4.8 mm). The distance from sternum to IMV gradually got narrower as it went caudally. In three cases the size of vein was not enough for anastomosis, but the bifurcation point may be used for anastomosis due to the wider point. Compared with the result of Caucasian, the incidence of bifurcation of internal mammary vein was lower and the level of bifurcation was higher. The result showed that the most successful level of anastomosis was the 3rd intercostal space in Korean due to shorter chest. The combination of 2DCT and US provided us with useful preoperative information as well as general anatomical data in Korean.