PMC6522979_01
(a) Clinical observation: erythema at the precordial operation scar. (b) Six months after surgery: no recurrence. (c) Preoperative computed tomography: sternal ablation and liquid retention. (d) Postoperative computed tomography: dead space filled with a pectoralis major muscle flap.
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On computed tomography, ablation of the sternum and liquid retention at the sternum were noted (Figure 1c). He visited our hospital on foot for 6 months after the operation and did not show recurrence (Figure 1b, d).
(a) Image during greater omentum filling. (b) Image obtained on the 14th postoperative day: cranial half of the greater omentum shows necrosis. (c) Imege after necrotic greater omentum removal: artificial blood vessel is exposed.
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Bleeding was stopped with a surgical clip, the mediastinal space was filled with the greater omentum, and the wound was closed (Figure 2a). The upper half of the greater omentum showed necrosis after the second hemostasis operation, and we removed the necrotic part surgically on the 14th day after the operation (Figure 2b). After removal, the artificial blood vessel was greatly exposed (Figure 2c).
Negative-pressure wound therapy with continuous instillation (NPWT-CI).
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NPWT-CI according to the method reported previously (Figure 3). NPWT-CI was performed for 31 days with a pressure setting of 75-100 mmHg and saline use of 2 L/day.
Reconstructive surgery. (a) Preoperative view. (b) Intraoperative view: dead space is filled with a right pectoralis major muscle flap. (c) Image after surgery.
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The dead space was filled with the greater omentum, which remained in the caudalis, and a left pectoralis major advancement muscle flap was used to close the wound (Figure 4).