Objective: Impaired parasternal skin perfusion (PSSP) after left intern mammary artery (LIMA)
harvesting in coronary arterial bypass surgery (CABG) reflects sternal hypo-perfusion
with potential risk of surgical site infection (SSI). We present the impact of pediculized
versus skeletonized LIMA-harvesting on PSSP by quantitative transcutaneous duplex
sonographic flow mapping. (TDSFM).
Methods: Bilateral TDSFM was performed before and after (postoperative day 5–7) CABG with
LIMA-harvesting on 3 parasternal levels (manubrium (M), corpus (C), xyphoid (X)) at
2 cm from midline. Left-sided PSSP was evaluated as % of a right-sided PSSP reference
(baseline-value). Data were prospectively collected and analyzed post-hoc.
Results: 5 patients received pediculized and 5 skeletonized LIMA-harvesting. Referring to
the right-sided baseline, mean (± SD) pre- / postoperative left-sided PSSP was 92.6 ± 15.4/66.8 ± 6.4%
(M), 95.6 ± 5.2/71.2 ± 5% (C) and 107 ± 13.8/76.4 ± 13.6% (X) after pediculized and
100 ± 3.4/100 ± 4.2% (M), 106 ± 14/99 ± 5.1% (C) and 106 ± 15.6/99.8 ± 5.2% (X) after
skeletonized LIMA-harvesting. There was a significant difference between left-sided
pre- and postoperative measures of 25.8%, 24.4% and 30.6% after pediculized LIMA-harvest
on level M, C and X, respectively (p = 0.043 (M), p = 0.043 (C), p = 0.043 (X), by Wilcoxon matched-pairs signed-ranks test). Significant difference
was absent after skeletonized LIMA-harvesting: 0%, 7% and 6.2% (p > 0.05 for all levels
M, C and X, by Wilcoxon matched-pairs signed-ranks test). Mean pre- to postoperative
PSSP decrease was 4.4% and 26.9% after skeletonized and pediculized LIMA-harvesting,
respectively.
Conclusion: A significant 26.9% impairment on average in postoperative parasternal skin perfusion
after pediculized compared with 4.4% after skeletonized LIMA-harvest suggests to routinely
consider skeletonized LIMA-harvesting especially in patients with increased risk for
SSI. Further prospective randomized studies are needed to confirm this trend.
