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J Thorac Cardiovasc Surg 2010;139:674-679
© 2010 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Skeletonized internal thoracic artery harvesting reduces chest wall dysesthesia after coronary bypass surgery

^a Cardiac Surgical Research Unit, CJ Officer Brown Cardiothoracic Unit, Alfred Hospital, Australia
^b Department of Neurology, Alfred Hospital, and Department of Medicine (Neuroscience), Monash University, Melbourne, Australia
^c Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia

Received for publication December 17, 2008; revisions received March 5, 2009; accepted for publication March 29, 2009.

^_* Address for reprints: Franklin Rosenfeldt, MD, FRACS, Cardiac Surgical Research Unit, The Alfred, PO Box 315, Prahran, Victoria 3181, Australia. (Email: f.rosenfeldt{at}alfred.org.au).

Objective: A pain syndrome related to intercostal nerve injury during internal thoracic artery harvesting causes significant morbidity after coronary bypass surgery. We hypothesized that its incidence and severity might be reduced by using skeletonized internal thoracic artery harvesting rather than pedicled harvesting.

Methods: In a prospective double-blind clinical trial, 41 patients undergoing coronary bypass were randomized to receive either unilateral pedicled or skeletonized internal thoracic artery harvesting. Patients were assessed 7 (early) and 21 (late) weeks postoperatively with reproducible sensory stimuli used to detect chest wall sensory deficits (dysesthesia) and with a pain questionnaire used to assess neuropathic pain.

Results: At 7 weeks postoperatively, the area of harvest dysesthesia (percentage of the chest) in the skeletonized group (n = 21) was less (median, 0%; interquartile range, 0–0) than in the pedicled group (n = 20) (2.8% [0–13], P = .005). The incidence of harvest dysesthesia at 7 weeks was 14% in the skeletonized group versus 50% in the pedicled group (P = .02). These differences were not sustained at 21 weeks, as the median area of harvest dysesthesia in both groups was 0% (P = .89) and the incidence was 24% and 25% in the skeletonized and pedicled groups, respectively (P = 1.0). The incidence of neuropathic pain in the skeletonized group compared with the pedicled group was 5% versus 10% (P = .6) at 7 weeks and 0% versus 0% (P = 1.0) at 21 weeks.

Conclusions: Compared with pedicled harvesting, skeletonized harvesting of the internal thoracic artery provides a short-term reduction in the extent and incidence of chest wall dysesthesia after coronary bypass, consistent with reduced intercostal nerve injury and therefore the reduced potential for neuropathic chest pain.

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