Anatomic and clinical considerations of an internal mammary artery harvest
T. J. Francel, C. R. Dufresne, W. A. Baumgartner and J. O'Kelley
Division of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.
In an effort to understand the perceived correlation of internal mammary
artery harvesting and wound healing difficulties in the inferior margins of
the sternotomy incision, we showed the cutaneous vascular perfusion in the
sternal and xiphoid areas by India ink injection studies in cadavers. With
these studies, we demonstrated an inherent paucity of nutrient supply to
the inferior sternum and xiphoid area. The classic internal mammary artery
harvest further compromises the blood supply to these areas. We believe
that limiting the most inferior dissection of the internal mammary artery
and not including the distal bifurcation leaves intact the lateral
musculophrenic nutrient supply to the inferior sternum and xiphoid area and
to the ipsilateral abdominal rectus muscle. These guidelines will help to
prevent ischemic complications of this area and may aid in reconstruction.
If the bifurcation is harvested, we believe that the removal of the
avascular xiphoid cartilage at the time of the initial bypass procedure may
eliminate this as a potential septic focus.
