eComment: Sternal microcirculation following pedicled or skeletonized internal thoracic artery harvesting.

Technical aspects of composite arterial grafting with double skeleton-ized internal thoracic arteries. Bilateral skeleton-ised internal thoracic artery graftings in off-pump coronary artery bypass: early result of Y versus in situ grafts. results of coronary grafting using ultrasonically skeletonized internal thoracic arteries. We read with great interest the recent review from Dr. Ali and coworkers w1x. Besides graft patency, sternal microcirculatory issues seem to favour skeletonized rather than pedicled internal thoracic artery (ITA) harvesting. Following pedicled conventional ITA harvesting, retrosternal capillary blood flow as well as retrosternal tissue oxygen saturation decrease significantly up to 50%, respectively w2x. In addition, pedicled ITA harvesting leads to retrosternal venous congestion. In case of experimental sternal infection in a porcine model, changes of microvascular sternal blood flow are evident depending on the applied pressure using vacuum-assisted closure (VAC) w3x. VAC has been suggested to stimulate blood flow in the peristernal region after ITA harvesting w4x. A clinical randomized trial compared pedicled vs. skeletonized harvesting techniques of the ITA with 24 consecutive patients enrolled w5x. Skeletonized ITA harvesting demonstrated significantly less deterioration of sternal micro-circulation with improved tissue oxygen saturation. Thus, from a microcir-culatory point of view, preserved internal thoracic veins faciliate venous outflow and diminish venous congestion, which otherwise might facilitate retrosternal infection in a clinical setting. of vacuum-assisted closure on blood flow in the peristernal thoracic wall after internal mammary artery harvesting. Sternal microcirculation after skeletonized versus pedicled harvesting of the internal thoracic artery: a randomized study.