Skeletonized internal mammary artery harvesting and grafting

Skeletonized internal mammary artery harvesting and grafting

Internal mammary artery harvesting is associated with reduced sternal perfusion and higher deep sternal wound infections, especially with bilateral internal mammary artery grafts and in diabetics. Reduced sternal perfusion can lead to increased and persistent post operative pain. Skeletonized internal mammary artery harvesting has been proposed as a potential solution to this problem. Skeletonization procedure was first described by Keeley in 1987 [Keeley SB. The skeletonized internal mammary artery. Ann Thorac Surg. 1987; 44: 324–325]. It involves the harvest of only the internal mammary artery without any surrounding tissue. Traditional internal mammary artery harvesting technique involves the dissection of a rim of tissue about one to two centimeters around the artery. This requires a more careful dissections and has a potential risk of arterial injury. But studies have not shown any difference in microscopic injury or vascular function between the conventional versus skeletonized harvesting of the internal mammary artery. Increased length and flow, decreased sternal infections and reduced pain are the proposed benefits of skeletonized internal mammary artery harvesting and grafting as compared to conventional method. It has been shown that there is significant reduction of postoperative pain and dysaesthesia with skeletonized grafts and increased sternal perfusion has been demonstrated, which can reduce the rate of deep sternal wound infection [Boodhwani M et al. Skeletonized Internal Thoracic Artery Harvest Reduces Pain and Dysesthesia and Improves Sternal Perfusion After Coronary Artery Bypass Surgery. A Randomized, Double-Blind, Within-Patient Comparison. Circulation. 2006; 114: 766-773].