September 1992

Anatomic and Clinical Considerations of an Internal Mammary Artery Harvest

Author Affiliations

From the Divisions of Plastic and Reconstructive Surgery and Cardiothoracic Surgery, The Johns Hopkins Hospital and The Johns Hopkins School of Medicine, Baltimore, Md. Dr Francel is now with Washington University School of Medicine, St Louis, Mo, and the Division of Plastic Surgery, The Jewish Hospital of St Louis.

Arch Surg. 1992;127(9):1107-1111. doi:10.1001/archsurg.1992.01420090115017

• 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.

(Arch Surg. 1992;127:1107-1111)