***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background — Observational studies suggest that skeletonization of the internal thoracic artery ( ITA ) can improve conduit flow and length and reduce deep sternal infections and postoperative pain . We performed a r and omized , double-blind , within-patient comparison of skeletonized and nonskeletonized ITAs in patients undergoing coronary surgery . Methods and Results — Patients ( n=48 ) undergoing bilateral ITA harvest were r and omized to receive 1 skeletonized and 1 nonskeletonized ITA . Intraoperatively , ITA flow was assessed directly and with a Doppler flow probe before and after topical application of papaverine . ITA harvest time and conduit length were recorded . A blinded assessment of pain ( visual analog scale ) and dysesthesia ( physical examination ) was performed at discharge , at 2 weeks , and at a 3-month follow-up . Sternal perfusion was assessed with nuclear imaging ( n=7 ) . Skeletonization required longer ITA harvest times ( 27±1 versus 24±1 minutes ; P=0.04 ) . There was a trend toward increased ITA length in the skeletonized group ( 18.2±0.3 versus 17.7±0.3 cm ; P=0.09 ) . In situ ITA flow was lower in skeletonized arteries ( 7.4±0.9 versus 10.1±1.0 mL/min ; P=0.01 ) and increased significantly after ITA division and papaverine application . Postanastomotic flows were similar between groups . Skeletonization was associated with decreased pain at the 3-month follow-up and a reduction in major sensory deficits at the 4-week and 3-month ( 17 % versus 50 % ; P=0.002 ) follow-ups . Baseline adjusted sternal perfusion was significantly greater by 17±6 % ( P=0.03 ) on the skeletonized side . Conclusions — Skeletonization results in reduced postoperative pain and dysesthesia and increased sternal perfusion at follow-up but does not produce increased conduit flow . ITA skeletonization may be a strategy for reducing morbidity after CABG OBJECTIVE Deep sternal wound infection is a dreaded complication of coronary artery bypass surgery , particularly in patients with diabetes . This study determines whether skeletonization of internal thoracic artery conduits compared with pedicled harvesting reduces the risk of deep sternal wound infection in patients with diabetes undergoing bilateral internal thoracic artery grafting .  METHODS We review ed prospect ively gathered data on all patients who have undergone coronary artery bypass grafting and received bilateral internal thoracic artery grafts at our institution since 1990 . We compared patients with diabetes who received skeletonized ( n = 79 ) versus conventional pedicled ( n = 36 ) internal thoracic artery conduits .  RESULTS The proportion of patients taking insulin ( 19.0 % vs 14.0 % for skeletonized vs conventional grafts , respectively , P = .6 ) or oral hypoglycemic agents ( 68.4 % vs 69.4 % , P = .9 ) , as well as the prevalence of type I diabetes ( 2.5 % vs 8.3 % , P = .18 ) , were similar in both groups . Patients who received skeletonized grafts were more likely to receive a free rather than an in situ right internal thoracic artery graft ( 93.7 % vs 30.6 % , P < .001 ) . The prevalence of deep sternal wound infection was significantly lower in patients who received skeletonized grafts compared with patients who received conventional grafts ( 1.3 % vs 11.1 % , P = .03 ) . Patients in the skeletonized group were also less likely to develop any ( superficial or deep ) sternal wound infection postoperatively ( 5.1 % vs 22.2 % , P = .03 ) . There was no significant difference in the prevalence of deep sternal wound infection between patients with diabetes who received skeletonized internal thoracic arteries  and patients without diabetes who underwent conventional internal thoracic artery grafting  ( n = 578 ) ( 1.2 % vs 1.6 % , respectively , P = .8 ) . CONCLUSIONS Skeletonization of internal thoracic artery conduits lowers the risk of deep sternal wound infection in patients with diabetes undergoing bilateral internal thoracic artery grafting .  We no longer consider diabetes a contraindication to bilateral internal thoracic artery grafting , provided the internal thoracic arteries are skeletonized BACKGROUND The skeletonization of internal thoracic artery is postulated to improve graft length , early blood flow , sternal blood supply , and postoperative respiratory function . Concern exists that skeletonization may injure internal thoracic artery , precluding good results of surgery . Reports on endothelial function of skeletonized internal thoracic artery are lacking . METHODS A prospect i ve assessment of early clinical outcomes of 357 consecutive patients undergoing coronary artery bypass grafting was performed : 287 patients with nonskeletonized and 70 with skeletonized left internal thoracic artery ( LITA ) .  The lengths of LITA and of its discarded distal segment , as well as free LITA blood flow , were measured . The dose-effect relationship for relaxation to  acetylcholine  was studied in the organ bath . RESULTS Apart from a higher incidence of breaching the pleura with nonskeletonized LITA the clinical outcomes were comparable . The length of skeletonized LITA was 17.8+/-1.14 cm versus 20.3+/-0.52 cm skeletonized ( p = 0.11 ) . The length of discarded LITA was shorter in nonskeletonized artery ( 0.8+/-0.28 cm versus 2.6+/-0.49 cm ; p = 0.022 ) . The free LITA blood flow was 66.3+/-7.42 mL/min in nonskeletonized vessel versus 100.3+/-14.84 mL/min in skeletonized ( p = 0.048 ) . The acetylcholine-induced relaxation was similar in both groups ( maximal relaxation , 80.7%+/-5.95 % in nonskeletonized versus 72.9%+/-9.11 % in skeletonized ; not significant ; negative logarithm of half-maximal effect , 7.43+/-0.18 versus 7.1+/-0.10 , respectively ; p = 0.063 ) . CONCLUSIONS Skeletonization does not damage the endothelial function of the LITA . Higher free blood flow and available LITA length should encourage the use of skeletonized LITA in clinical practice To minimize sternal ischemia , skeletonized internal mammary artery ( IMA ) harvesting has been performed in the last few years . The benefits of skeletonization in high risk patients , such as diabetic patients undergoing bilateral IMA grafting , are unknown . A total of 99 patients underwent isolated coronary artery bypass grafting ( CABG ) using a pedicled bilateral IMA between 6/1/1997 and 5/31/2000 ( group P ) , and 115 patients receiving a skeletonized IMA between 6/1/2001 and 3/31/2002 ( group S ) . An ultrasonic scalpel was used for skeletonization . The perioperative and early angiographic results of CABG using these two techniques were collected prospect ively and compared . There were two ( 1.7 % ) perioperative myocardial infa rct ions in group S and one ( 1.0 % ) in group P ( P = NS ) , none of which were related to the IMA graft . The incidence of mediastinitis was one ( 0.9 % ) in group S and three ( 3.0 % ) in group P , P = NS , however , minor chest wound complications were observed in four ( 3.5 % ) in group S , which was significantly less frequent than the 12 ( 12.1 % ) in group P ( P<0.05 ) . Angiographic control was obtained in 87 patients in group S and 36 in group P , revealing no IMA occlusions in either group . Bilateral skeletonized IMA grafting for diabetic patients is safe and may decrease wound complications OBJECTIVE The incidence of wound infection in coronary artery surgery is low , but there is an appreciable mortality associated with sternal infection . In other fields of surgery there is evidence that an all disposable paper gown and drape system has protective advantages over a fabric system . Using an established wound scoring system ( ASEPSIS ) , we investigated this in a prospect i ve , r and omised trial of patients undergoing cardiac surgery . METHODS 505 patients undergoing isolated coronary artery surgery in a single hospital over an 18 month period were r and omised to either a disposable , paper drape system or re-usable fabric drapes . Allocation was stratified according to whether or not the patient had had previous coronary artery surgery . Patients were followed for 3 months . Total infection scores for each wound were calculated from daily scores collected in hospital together with the scores at six weeks and three months . RESULTS The two r and omised groups were otherwise well matched . Full follow-up information was available for 464 ( 92 % ) patients . There was no evidence of any difference in rates of sternal or leg wound infection between the two groups ( P = 0.87 and 0.62 , respectively ) . Women were more likely to have infected sternal wounds ( P = 0.17 ) and significantly more likely to have infected leg wounds ( P = 0.04 ) . Patients with sternal wound infections  had a significantly higher body mass index ( P = 0.001 ) . High Parsonnet scores and increased time on ventilation were significantly associated with leg wound but not sternal infections . For both wound sites , patients with infections had spent longer in the operating theatre . CONCLUSION In a r and omised controlled study of patients undergoing coronary artery surgery we found that the use of paper drapes and gowns conferred no benefit over a reusable fabric in terms of post-operative wound infection . Although females and diabetics are more likely to experience this complication , an important additional risk factor is an extended operating time OBJECTIVE The internal thoracic artery ( ITA ) is the ideal conduit for coronary artery bypass grafting ( CABG ) . The skeletonization technique of this arterial conduit has been proposed to reduce chest wall trauma , increase graft length and facilitate construction of sequential anastomoses . Nevertheless , some surgeons decline this technique because of potentially increased trauma to the ITA with impairment of flow . In this investigation we compared the free flow of skeletonized with that of pedicled ITA grafts . METHODS Two surgeons operated on 80 consecutive patients with coronary artery disease for elective CABG . In group I ( n = 40 ) , the left ITA was dissected using the skeletonization technique . In group II ( n = 40 ) , it was harvested as a pedicled graft . In 23 patients of group I both ITA 's were dissected in skeletonized fashion for complete arterial revascularization . Diluted papaverine was instilled into the lumen of the ITA after distal transection of the vessel in both groups . Free flow of the ITA was registered before and 15 min after intraluminal application of diluted papaverine .  Mean arterial pressure was maintained at 70 mmHg . RESULTS Before the application of papaverine , free flow of skeletonized and pedicled ITA grafts was identical between the two groups . After treatment with papaverine maximum free flow was significantly higher in the skeletonized ITA 's ( group I 197.2 ( + /-66.6 ) ml/min ; group II 147.1 ( + /-70.5 ) ml/min ; P < 0.05 ) . There was no significant difference between free flow after dilatation of the left and right ITA in group I ( left 197.2 ( + /-66.6 ) ml/min ; right 198.9 ( + /-61.8 ) ml/min ) . CONCLUSIONS Preparation of the ITA with the skeletonization technique results in significantly , higher free flow capacity than in pedicled grafts . This may increase the safety of arterial revascularization by reducing the risk of ITA hypoperfusion syndrome OBJECTIVE To evaluate the role of intact pleurae regarding the postoperative respiratory functional status in patients undergoing coronary revascularization employing both internal mammary arteries ( IMAs ) , according to the pedunculated or skeletonized technique ( SKT ) with opened or intact pleurae . MATERIAL S AND METHODS Using both IMAs , 299 patients underwent elective coronary revascularization .  They were r and omized and divided into group I ( n=82 , undergoing IMA harvesting according to the SKT without opening the pleurae ) ; group II ( n=186 , undergoing IMA harvesting according the pedunculated technique with open pleurae ) ; and group III ( n=31 , undergoing IMA harvesting according the SKT with incidentally opened pleurae ) . There were no differences regarding the preoperative patient characteristics and the anaesthetic and surgical management . RESULTS There were two deaths in group I versus seven in group II and one in group III ( P = ns ) . The number of total arterial myocardial revascularization and arterial composite grafts was significantly higher in groups I and III than in group II , ( P<0.001 and P<0.005 , respectively ) . The incidence of 
    Output:
    
In conclusion , skeletonized ITA appears to reduce the incidence of postoperative SWI in comparison with pedicled ITA  after CABG , with this effect being modulated by the presence of diabetes