固体硅胶假体雕刻的改进

作者为使固体硅橡胶假体柔软及表面粗糙化,采用百叶状切割及边缘毛刺状修剪法雕刻假体,进行隆鼻,丰下颌及颞部充填术４６例,避免了术后并发症,取得了良好效果。一、临床资料１９９６年３月～１９９９年１月,采用固体硅橡胶假体行隆鼻术３１例,女２９例,男２例。丰...     

Poland综合征胸部畸形的整复

目的:探讨矫治Poland综合征胸部畸形的手术方法。方法:2006年8月至2012年8月,笔者对3例年龄分别为21岁、18岁和10岁的女性Poland综合征患者进行了胸部畸形的整复。3例患者均有胸肌发育不良及肋软骨部分缺如等畸形,但上肢形态和功能均未见异常。其中21岁患者行"右侧背阔肌肌瓣带蒂移植术及硅胶假体植入隆乳术",18岁患者行"水动力腹部脂肪抽吸术及左胸部自体脂肪移植术",10岁患儿行"左侧多余乳头切除术",待成年后来我科行患侧胸壁及乳房II期修复术。结果:术后密切随访,患者胸部凹陷畸形均得到不同程度的改善,手术效果持续时间长,患侧上肢及胸背部功能未受影响,提高了患者自信心和生活质量。结论:Poland综合征是一种涉及多部位、变异性较大的先天性畸形,应根据患者的自身特点制定个性化的手术方案,方可取得满意的治疗效果。     

背阔肌肌瓣转移修复Poland综合征胸部畸形

目的 探讨背阔肌肌瓣转移矫治Poland综合征胸部畸形的方法与注意事项。方法 10例患者采用侧胸垂直切口及腋下小切口切取转移背阔肌肌瓣矫正胸壁畸形,注意腋前皱襞的重建。结果 10例背阔肌肌瓣全部成活,随访1～2年,效果良好。结论 背阔肌肌瓣具有稳定、可靠的血供保证,能提供足够的组织量,是修复Poland综合征胸部畸形的理想方法。     

内镜辅助下切取背阔肌瓣结合假体隆胸修复Poland综合征

目的 探讨Poland综合征乳房不对称畸形的微创修复方法. 方法 在内镜辅助下,采用腋窝皱襞、胸背部小切口,剥离乳腺后间隙、背阔肌前缘及浅、深面,保留血管蒂完整性,切取背阔肌岛状皮瓣,通过皮下隧道转移至胸部乳腺后间隙后分点与深部筋膜固定,再造腋前襞等结构,Ⅱ期结合腋窝入路硅凝胶假体隆胸修复Poland综合征1例,重点分析切口选择、内镜辅助下背阔肌瓣剥离、蒂部游离等手术操作要点. 结果 术后随访2年,腋前襞成形好,再造乳房外形自然,双侧不对称明显改善,手术切口瘢痕愈合好,总体修复效果优良. 结论 内镜辅助下背阔肌带蒂转移术结合假体隆胸修复Poland综合征患者腋前襞及乳房不对称畸形美容效果好,手术创伤小,并可有效地减少手术切口瘢痕,是一种较好的方法.     

用固体硅橡胶假体隆鼻300例体会

用固体硅橡胶假体隆鼻３００例体会浙江省兰溪市皮肤病防治站（３２１１００）郑碧忠从１９８８年１０月～１９９３年１０月使用固体硅橡胶作隆鼻术３００例，并对其进行了随访分析。１临床资料本组共３００例，其中男性２７例，女性２７３例；年龄１９～６０岁，术后时间...     

Poland综合征临床特点与治疗

目的 根据Poland综合征的临床特点,探讨其治疗策略.方法 对15例患者进行回顾性研究,将Poland综合征胸部畸形分为4类:轻度,女性;重度,女性;轻度,男性;重度,男性.分别行自身软组织填充或(和)硅凝胶乳房假体置入术.结果 随访6个月至4年,全部患者胸部外形对称,肌瓣全部成活,无假体包膜挛缩、移位,手术效果满意.结论 Poland综合征临床表现多样,分类方法能够简单而有效指导临床进行个性化治疗,疗效满意.背阔肌肌瓣带蒂或游离移植填充,女性患者结合乳房假体置入,是矫正重度Poland综合征胸部畸形的首选方法.     

Poland综合征临床特点与治疗

目的 根据Poland综合征的临床特点,探讨其治疗策略.方法 对15例患者进行回顾性研究,将Poland综合征胸部畸形分为4类:轻度,女性;重度,女性;轻度,男性;重度,男性.分别行自身软组织填充或(和)硅凝胶乳房假体置入术.结果 随访6个月至4年,全部患者胸部外形对称,肌瓣全部成活,无假体包膜挛缩、移位,手术效果满意.结论 Poland综合征临床表现多样,分类方法能够简单而有效指导临床进行个性化治疗,疗效满意.背阔肌肌瓣带蒂或游离移植填充,女性患者结合乳房假体置入,是矫正重度Poland综合征胸部畸形的首选方法.     

Poland综合征合并乳腺癌1例

Poland综合征是一种少见的先天性畸形，又称胸大肌缺损并指综合征（pectoralis deficiency syndatyly syndrome）。表现为单侧胸壁的畸形和多种表现的上肢畸形。本文报告Poland综合征合并乳腺癌1例。     

手术矫治Poland 综合征

目的探讨手术矫治Poland 综合征的方法. 方法 1990年5月～2002年5月,对3例年龄分别为3、12和16岁的女性Poland综合征患儿进行了胸壁成形术矫治,患儿均有胸大肌缺如、胸小肌发育不良及肋软骨缺损等畸形.其中1例行自身肋软骨移植、右侧背阔肌移位术,另2例行自身肋软骨移植、涤纶布片修补术. 结果术后分别随访1、7和10年,结果显示患儿胸壁外观恢复满意,患侧上肢及胸背部功能正常,生长发育无异常. 结论 Poland综合征是一组涉及多部位的先天畸形,应根据病变的程度和范围制定手术治疗计划,方可取得较满意的效果.     

部分同侧背阔肌肌瓣修复Poland综合征胸壁畸形

Poland综合征是并不少见的先天畸形 ,发病原因尚不清楚 ,典型征候群包括同侧胸壁及上肢畸形。 2 0 0 0年 9月～2 0 0 2年 5月 ,我们应用同侧部分背阔肌肌瓣修复男性Poland胸廓畸形 2例 ,效果较满意。1　临床资料本组 2例 ,均为男性 ,年龄分别为 19及 2 5岁 ,均表现为右侧部分胸大肌缺失。2　手术方法用美蓝在体表标出需修复的胸大肌范围和背阔肌的切取范围。在患侧胸壁距腋窝底 2cm处起行长 18cmS状切口 ,达深筋膜浅面 ,在此层向腋窝、脊柱及髂嵴方向分离至背阔肌外侧约 2 3处 ,切断背阔肌的起点 ,从其下层向腋窝方向分离 ,找到背阔肌在…     

Chest Wall Implants: Their Use for Pectus Excavatum,Pectoralis Muscle Tears,Poland's Syndrome,and Muscular Insufficiency

Solid customized and prefabricated silicone implants have been used by the author for 15 years in a wide range of chest wall deformities. Chest wall implants are often used in males seeking to augment a muscularly deficient or underdeveloped chest; however, their greatest use has come in a variety of deformities both congenital and acquired, such as pectus excavatum, Poland's Syndrome, and pectoralis muscle tears. The implants can be either customized using a moulage technique or are prefabricated, manufactured implants which can be modified on the operating table to repair the contour deformity. The immediate postoperative problem of seroma and subcutaneous implant ``show' has been minimized by careful planning, gentle technique, deep insertion, improved patient positioning on the operating room table, and the use of oral anti-inflammatory medications. The long-term results of these implants seem very satisfactory. The patients are usualy physically active, and the implants show no long-term sequelae such as seroma, infection, displacement, or rupture.     

Poland's syndrome with rare deformities: reconstruction with latissimus dorsi muscle through a single short incision.

We describe a 22-year-old man with Poland's syndrome and two other rare deformities which, to our knowledge have not been reported previously. The first deformity was a fibrotic band between the nipple-areola complex and the medial epicondyle of the humerus, and the second was a fifth digit with two phalanges. A single midaxillary vertical incision was used to harvest and then transfer the latissimus muscle for soft tissue reconstruction of the chest wall deformity. Almost complete symmetry was achieved and the scar was well hidden by the arm. The aesthetic and functional results were satisfactory.     

Surgical treatment of thoracic deformity in Poland's syndrome

In 1841, Poland described congenital deficiency of the pectoralis major and minor muscles associated with syndactyly. This syndrome is a spectrum, often involving chest wall and breast deformity as well. Identification of the various musculoskeletal components involved permits optimal thoracic reconstruction in the small proportion of patients who will require it. From 1955 to 1988, 75 patients (40 males and 35 females) with Poland's syndrome were treated or evaluated. Patients with isolated deficiencies of the pectoral muscles, breast, or hand deformity were excluded. The complex was right-sided in 44 patients, left-sided in 30, and bilateral in one. The pectoralis minor and the costal portion of the pectoralis major muscle were absent in all patients. Hand anomalies were present in 50 patients. Athelia and/or amastia were noted in 37 patients. In ten patients, the rib cage deformity required reconstruction, and in three cases, rib or cartilage grafts were needed for complete repair. Often unappreciated in these cases is the significant rotation of the sternum toward the involved side and contralateral carinate deformity. Correction is achieved by bilateral subperichondrial costal cartilage resection and sternal osteotomy (seven of ten patients), thus allowing anterior displacement and orthorotation of the sternum. Chest wall reconstruction must be tailored to the requirements of each patient. No intraoperative or postoperative complications occurred in these ten patients. In males without rib cage deformity, generally no treatment is required to replace the absent pectoral muscles, although in two cases rotation of the latissimus dorsi muscle was performed. In all females, reconstruction of the ipsilateral breast is required at full development.(ABSTRACT TRUNCATED AT 250 WORDS)     

Free gracilis flap for chest wall reconstruction in male patient with Poland syndrome after implant failure

Poland''s syndrome (PS) is a congenital monolateral deformity that may involve breast, chest wall, and upper limb with different degrees of clinical expressions. In some cases, the problem is mainly cosmetic, and the reconstruction should be performed to achieve minimal scarring and donor site morbidity. The authors describe a case report of a male patient with PS who developed a severe capsular contraction after 25 years implant reconstruction, who was treated after explantation using free gracilis flap (FGF). In this patient, only the pectoralis major muscle was missing. An FGF was performed to reconstruct the anterior axillary fold and the soft tissue defect. There was no flap loss, the patient had a clearly improved appearance of the chest wall, and the pain syndrome was solved. In this case report, we demonstrate our experience with the use of an FGF for chest wall reconstruction in male patients with PS after prosthesis explantation.KEY WORDS: Capsular contracture, chest wall deformity, gracilis free flap, Poland''s syndrome     

Reconstruction of congenital chest-wall deformities

Pectus deformities and Poland's syndrome are two relatively common congenital deformities of the chest wall that are amenable to reconstruction. The extent of the structural deformity in pectus deformity and the degree of associated cardiopulmonary dysfunction are critical variables in preoperative assessment. The operative approaches range from more extensive sternal eversion to the more popular subperichondrial cartilage resection with or without internal fixation. In Poland's syndrome, the options for reconstruction include anterior transfer of the ipsilateral latissimus dorsi muscle through a transaxillary tunnel and attachment to the clavicle and sternum. Submuscular insertion of a mammary prosthesis can be added in the female patient.     

Poland综合征临床特点与治疗

目的 根据Poland综合征的临床特点,探讨其治疗策略.方法 对15例患者进行回顾性研究,将Poland综合征胸部畸形分为4类:轻度,女性;重度,女性;轻度,男性;重度,男性.分别行自身软组织填充或(和)硅凝胶乳房假体置入术.结果 随访6个月至4年,全部患者胸部外形对称,肌瓣全部成活,无假体包膜挛缩、移位,手术效果满意...     

The transverse musculocutaneous gracilis flap for chest wall reconstruction in male patients with Poland's syndrome

Poland's syndrome represents a congenital unilateral deformity of the breast, chest wall, and upper limb with extremely variable manifestations. In most cases, the problem is mainly cosmetic, and the reconstruction of the chest wall should use a method designed to be performed easily and to achieve minimal scarring and donor site morbidity. We describe using a transverse musculocutaneous gracilis (TMG) flap for chest wall and anterior maxillary fold reconstruction in three male patients. In two patients, only the pectoralis major muscle was missing. In the third case, the ipsilateral latissimus dorsi muscle was also absent. The indication for surgical treatment was purely cosmetic. In all patients, a free TMG flap was performed to reconstruct the anterior axillary fold and the soft tissue defect. There was no flap loss, and all three patients had a clearly improved appearance of the chest wall. In this article, we demonstrate our experience with the use of a TMG flap for chest wall reconstruction in male patients with Poland's syndrome. © 2013 Wiley Periodicals, Inc. Microsurgery, 2013.     

Use of the pectoralis minor in the creation of a submuscular pocket in breast reconstruction

Summary The placement of expanders and implants used in breast reconstruction in a submuscular position has been associated with a significant reduction in the number of complications. To create a submuscular pocket and properly position the prosthesis under the breast mound, the muscular attachments to the anterior chest wall must be surgically released. We have found that by splitting the pectoralis minor along its long axis and elevating the lateral half of this muscle in-continuity with the serratus anterior muscle, the lateral portion of the submuscular pocket can be accurately dissected under direct vision. Incorporation of the lateral half of the pectoralis minor in the muscle closure then allows for a larger pocket to be created giving more versatility in choosing the size of an expander or implant. Clinical experience with this technique has proved it to be a reliable modification of submuscular pocket creation for breast reconstruction.