可降解生物材料人工胸壁重建犬胸壁缺损的实验研究

目的采用甲壳素短纤维增强聚己内酯(PCL)制备的人工胸壁,构建犬胸壁缺损与重建动物模型,探讨可降解生物材料人工胸壁重建胸壁缺损的可行性。方法实验犬8只,建立面积10cm×10cm的犬胸壁缺损动物模型,用甲壳素短纤维增强PCL板修复胸壁骨性缺损,通过X线、胸部CT及组织学动态观察人工胸壁的植入状况及胸壁组织的再生过程。结果所有实验犬无手术死亡和围手术期死亡,无胸壁塌陷及反常呼吸,无感染,无严重并发症。人工胸壁材料与周围胸壁肋骨及肌肉组织结合好,界面良好,固定牢靠。术后6个月甲壳素短纤维增强PCL板被纤维组织包裹。结论甲壳素纤维增强聚己内酯复合材料具有良好的生物相容性、可降解性和适宜的力学强度,能够对胸壁提供有效的支撑作用,易塑形和任意修剪,可透过X线,是一种很有前景的胸壁缺损修复材料。     

胸壁、胸膜

胸腔镜辅助下漏斗胸矫正术的初步观察；甲壳素长纤维增强聚己内酯的制备及重建犬胸壁缺损的实验研究；中段胸骨切除自体肋骨移植重建一例     

胸壁大块缺损外科重建71例报告

目的 探讨胸壁大块缺损后不同外科技术重建的效果.方法 1995年9月至2005年9月对71例不同病因的胸壁大块缺损患者采用多种方法 进行胸壁重建.骨性胸廓重建采用自体组织(肋骨条、阔筋膜、肌瓣)或人工材料(Dacron片、聚四氟乙烯网片 钛合金条、金属丝支架加大网膜片、Dacron和骨水泥构成的三明治式复合体).皮下软组织修复主要应用转移皮瓣、肌皮瓣或大网膜瓣.结果 全组无手术死亡和局部肿瘤复发,2例因感染摘除金属植入物.术后呼吸功能良好,无反常呼吸运动.结论 背阔肌瓣和大网膜瓣修复软组织效果较好,后者对因感染引起的胸壁缺损效果更佳.Dacron片和骨水泥构成的三明治式复合体适用于大块骨性胸廓缺损的重建.     

人工补片胸壁重建治疗胸壁巨大缺损

目的总结应用人工补片胸壁重建治疗胸壁巨大缺损的疗效。方法 2002年1月-2008年10月,收治14例胸壁肿瘤患者。男10例,女4例;年龄28～67岁,平均45岁。原发性肿瘤11例,转移性肿瘤3例。肿瘤位于前胸壁5例,后胸壁3例,侧胸壁6例。病程20～270 d。患者均行扩大根治切除术,切除2～5根肋骨,胸壁缺损范围9 cm×7 cm～17 cm×12 cm,采用单层或双层Marlex网片结合自体肌肉瓣覆盖重建胸壁。结果患者均顺利完成手术。术后切口均Ⅰ期愈合。胸壁无明显反常呼吸。14例均获随访,随访时间13～26个月,平均21个月。随访期间未出现与材料有关的宿主反应。患者胸壁无明显畸形,外观良好,呼吸运动时胸壁重建处无不适。1例因肿瘤复发伴肝脏转移死亡。结论人工补片胸壁重建治疗胸壁巨大缺损安全、有效。     

胸壁肿瘤切除后胸壁大块缺损的修复重建

目的探讨胸壁肿瘤切除后胸壁大块缺损的修复重建方法。方法回顾性分析近10年来24例胸壁肿瘤切除后胸壁大块缺损患者的临床资料,24例患者均联合应用不锈钢丝和绦纶补片进行胸壁重建。结果全组无手术死亡,无胸壁软化及反常呼吸运动,无切口感染,1例术后发生伤口局部积液。全组患者术后随访1月～10年,无1例钢丝断裂及反常呼吸,胸壁凹陷畸形不明显,胸廓外形的满意率达95.8%（23/24）。结论不锈钢丝和涤纶补片是修复重建胸壁大块缺损的一种很好材料,取材方便,操作简便,胸廓稳定性良好,临床疗效确切。     

聚对二氧环己酮网制备及重建犬胸壁缺损的研究

目的 通过生物材料的选择和制备,研制新型可降解人工胸壁修复材料,并通过动物实验探讨其用于胸壁重建的可行性.方法 采用聚对二氧环己酮(PDO)纤维编织成网状结构人工胸壁,应用于犬胸壁缺损重建动物模型,8、16、24周处死实验犬,观察人工材料降解变化、材料与组织结合界面、胸壁再生情况.结果 PDO网可以重建胸壁稳定性,并在24周内逐步降解吸收,由机体再生组织完全取代.结论 PDO网具备适宜的可降解特性,作为胸壁重建材料,可获得有效胸壁稳定,具有良好临床应用前景.     

胸壁肿瘤切除术胸壁缺损钛网重建五例

胸壁肿瘤的根治性大块切除所致的胸壁缺损必将破坏胸膜腔的密闭性和胸廓的坚固性与稳定性,容易导致血气胸、胸壁软化、反常呼吸及纵隔摆动、低氧血症、伤口和肺部感染、肺动脉栓塞等,严重影响呼吸循环功能。因此,对胸壁大块缺损必须予以妥善的修复。我院于2010年5月至2013年11月为5例胸壁肿瘤患者施行胸壁肿瘤扩大切除术,用钛网修补缺损,效果满意,现总结其临床经验。     

人工材料胸壁重建研究进展

影响胸壁缺损重建的因素很多 ,但主要是缺损的部位、大小和深度。缺损范围较小或特殊部位的缺损 ,如前胸壁直径小于 5cm ,后胸壁小于 10cm ,一般直接缝合即可。但全层大块胸壁缺损 ,尤其在前胸壁及侧胸壁 ,范围超过 6cm× 6cm且相连 3根以上肋骨受损时 ,应考虑行胸壁骨性重建 ,以恢复胸廓的坚固性和稳定性 ,否则术后将引起胸壁软化和反常呼吸 ,造成呼吸、循环的紊乱〔1 - 5〕。重建胸壁缺损的材料分为自体组织、同种异体组织和人工材料。自体组织和同种异体组织虽然被认为是最符合人体生理的修复材料 ,但取材有限、增加创伤、增加手术难度、…     

膨体聚四氟乙烯补片在胸壁重建中的应用

目的分析膨体聚四氟乙烯(Gore-Tex)补片在胸壁重建中的注意事项,总结临床应用经验。方法回顾性分析第二军医大学长海医院2001年1月至2010年l2月期间33例使用Gore-Tex补片进行修复巨大胸壁缺损的临床资料,男19例,女14例;平均年龄45.7(20～73)岁。根据肿瘤位置、大小选择不同的手术切口;术中尽量保留正常的胸壁软组织,骨性胸壁缺损采用Gore-Tex补片进行重建,软组织直接对拢缝合,全层胸壁缺损采用转移肌皮瓣覆盖创面。结果全组33例均手术顺利,围术期无死亡患者;恶性肿瘤25例,良性肿瘤8例,均被完整切除,切除瘤体直径8～20 cm。随访5～60个月,失访3例(9.09%),无排斥反应及反常呼吸,无异物感,感染率3%(1/33)。结论 Gore-Tex补片具有极佳的生物相容性,是安全有效的胸壁重建材料;选择合适的肌皮瓣覆盖补片,能够减少并发症发生。     

胸壁全层缺损的修复重建

目的探讨胸壁全层缺损的修复重建方法及疗效。方法 2006年1月-2010年12月,收治14例胸壁全层缺损患者。男8例,女6例;年龄23～65岁,平均42岁。恶性肿瘤切除术后继发胸壁全层缺损12例,乳腺癌术后继发放射性损伤1例,热压伤1例。缺损范围为8 cm×5 cm～26 cm×14 cm。所有患者均伴肋骨缺损(1～5根),3例伴胸骨缺损。术中10例患者应用涤纶网或聚四氟乙烯补片行骨性重建,4例未作骨性重建。分别采用双叶皮瓣、胸大肌肌皮瓣、背阔肌肌皮瓣、腹直肌肌皮瓣修复软组织缺损,皮瓣切取范围为10 cm×7 cm～25 cm×13 cm。供区直接拉拢缝合或游离植皮修复。结果术后2例发生创面愈合不良,经再次彻底清创、肌皮瓣修复和补充植皮后愈合;其余皮瓣均顺利成活,创面Ⅰ期愈合。术后患者均获随访,随访时间6～36个月,平均8个月。除1例骨肉瘤患者因肝转移于术后6个月死亡,其他肿瘤患者随访期间均无复发。热压伤患者未同期行胸壁骨性重建,术后5 d出现短暂轻度反常呼吸,其他患者术后胸廓稳定性良好,无明显反常呼吸及呼吸困难。结论根据胸壁缺损病因、面积和部位,单独或联合应用局部皮瓣或肌皮瓣进行胸壁软组织缺损修复,必要时应用人工材料行胸壁骨性重建,可有效修复严重胸壁全层缺损。     

A new alternative for bony chest wall reconstruction using biomaterial artificial rib and pleura: animal experiment and clinical application

Objective: To evaluate a new method for chest wall reconstruction using porcine-derived artificial rib and pleura in an animal experiment. Further, the clinical application was performed in five patients with large defects in the chest wall as a preliminary observation. Methods: In animal experiments, a full-thickness chest wall defect of 7 cm × 8 cm was created in 12 adult mongrel dogs. Six dogs underwent reconstruction with porcine-derived artificial ribs and pleura (test group), and six with methylmethacrylate and double polyester mesh in the form of traditional Marlex sandwich technique (control group). At follow-up of each for 3, 6, and 12 months postoperatively, a general performance assessment and thoracic radiography were performed. Gross and histopathological examinations were carried out following humane euthanasia at the time of last follow-up. In clinical application, five patients with wide tumor resection in the chest wall underwent reconstruction with porcine-derived artificial ribs and pleura as well. Results: In animal experiment, no perioperative death or hyperpyrexia occurred and no difference in either infection or dyspnea was noted between the two groups. Postoperative radiography revealed good thoracic integrity with no evidence of collapse, deformation, or abnormal movement in the test group. In the control group, similar results were observed, except that two dogs had abnormal movement in the chest wall associated with respiration. Severe adhesions between the ‘sandwich’ complex and the host tissues were identified in the control group, but by contrast, only mild adhesions were noted in the test group. The non-degradable polyester mesh induced fibrous proliferation and rejection, whereas the artificial pleura was absorbed with mild fibrous hyperplasia after 12 months. In clinical application, no thoracic deformity, chronic pain, or respiratory discomfort were observed at 1 or 12 postoperative months. Conclusions: Porcine-derived ribs and pleura can be employed safely to create an artificial chest wall to repair bony chest defects. The clinical results corresponded well with those of animal experiments, and thus confirmed the safety and feasibility of this new alternative of chest wall reconstruction. However, a long-term study in a large number is needed due to the small number of animals in this study.     

Combined reconstruction of complex defects of the chest wall.

Defects of the chest wall are often encountered, and good results can be obtained both cosmetically and functionally from their treatment. We treated 13 patients with full thickness chest wall defects. Follow up ranged from 12 days to 19 months. Three had had recurrent breast carcinoma, seven relapse after excision of a sarcoma, two had had lesions of the chest wall after irradiation, and one had a sternal fistula. Local skin, musculocutaneous and free latissimus dorsi and anterolateral thigh flaps were done to cover soft tissue. Fascia lata, polypropylene (Marlex) mesh, and Marlex mesh-methylmethacrylate sandwich prosthesis, were used to stabilise the skeleton in nine patients. Two of the patients died postoperatively, one early. The use of Marlex mesh-methylmethacrylate sandwich prostheses for the stabilisation of the skeleton and local musculocutaneous flaps for covering soft tissues after resection of three or more ribs is effective.     

An experimental study of successful tracheal replacement using pedicled latissimus dorsi muscle flap and soft Marlex mesh

The present experimental study was undertaken to evaluate the efficacy of combined latissimus dorsi muscle flap and soft Marlex mesh in the reconstruction of the trachea. Thirty-one mongrel dogs underwent a two-stage operation. In the first stage operation, they were divided into four groups for implanting a different prosthesis. A silicone rod was used as the core and this was rolled with soft Marlex mesh to make a prosthesis (Group A and B: without reinforce, Group C: reinforced by wrapping stainless steel mesh, Group D: reinforced with helical stain steel wire). The latissimus dorsi muscle flap was rolled circumferentially around the prosthesis and it was left in place for a period of 4 to 6 weeks. In the second stage operation, the long pedicled muscle flap with the biologically organized prosthesis was mobilized to be guided into the cervix, and the tracheal reconstruction was done with them following circumferential tracheal resection. In result, five of six dogs of group D survived more than 6 months after the replacement without anastomotic leakage or stenosis causing inflammatory granulation. Organization with neo-vascularity of the prosthesis at the time of the tracheal reconstruction was important firstly to avoid incurring complications concerning anastomosis and secondly for long-term stability of the healing and epithelialization of the prosthesis.     

甲壳素短纤维对聚己内酯体内的降解作用

目的 对纯聚己内酯（PCL）和甲壳素短纤维增强PCL复合材料进行体内降解实验研究，观察其理化性能变化及组织反应情况，为临床应用提供有价值的实验依据。方法 将纯PCL和甲壳素短纤维增强PCL植入兔背部脊柱两侧肌肉内，于2、4、8、12、16、24周取材，分别测试两种材料的生物吸收率、弯曲强度和弯曲模量，并行组织学和透视电镜观察。结果 甲壳素短纤维增强PCL初始强度大于纯PCL，在体内植入过程中，生物吸收率大于纯PCL，力学性能先高后低，强度和模量值24周时与初始值相差不大。未见材料周围组织变性、坏死或肉芽肿异常增生现象。结论 PCL复合甲壳素纤维后，加快降解速度，提高力学性能，材料-组织界面炎性反应轻，是一种具有开发价值的新型胸壁缺损修补及骨科内固定材料。     

A case report on a full-thickness chest wall reconstruction with polypropylene mesh and stainless steel mesh concurrently using a transverse rectus abdominis myocutaneous flap.

A full-thickness chest wall resection requires subsequent chest wall reconstruction. A chest wall resection and reconstruction was performed using a transverse rectus abdominis myocutaneous (TRAM) flap, together with polypropylene mesh (Marlex mesh) and stainless steel mesh (SSM). A 71-year-old man was diagnosed as having recurrent lung cancer in the chest wall, and underwent surgical resection. Marlex mesh was sutured to the posterior wall of the surgical defect. A portion of the SSM was adjusted to the size of the defect and cut out. Its edges were folded to make the portion into a plate. This SSM plate was placed anteriorly to the Marlex mesh and sutured to the ribs. The Marlex mesh was folded back on the SSM plate by 2 cm and fixed. After the above procedures, a left-sided TRAM flap was raised through a subcutaneous tunnel up to the defect and sutured to the region. The patient was discharged from hospital 19 days postoperatively. The wound was fine and he had no flail chest or dyspnea, and carcinomatous pain resolved.     

Resection of Sternal Tumors and Reconstruction of the Thorax: A Review of 15 Patients

Purpose We report our experience of resecting sternal tumors, followed by reconstruction of the skeletal and soft-tissue defects, and discuss the usefulness of sandwiched Marlex and stainless-steel mesh. Methods Fifteen patients underwent resection of a sternal tumor and chest wall reconstruction with autologous bone grafts, sandwiched Marlex and stainless-steel mesh or a titanium plate, and musculocutaneous flaps. The sternal tumors were from locally recurrent breast carcinoma in ten patients, metastasis from other organs in three, and primary chondrosarcoma in two. Results All patients were extubated without paradoxical respiration just after surgery. There was no operative mortality. A wound infection developed in the acute phase after a sandwiched Marlex and stainless-steel mesh reconstruction in one patient. A second repair with Marlex and stainless-steel mesh was required in two patients; for flail chest after an autologous bone graft in one; and following re-recurrence of breast carcinoma in another patient who had undergone a musculocutaneous flap repair. No signs of breakdown, dislodgment, severe depression, or deformity were seen in any of the six patients who underwent reconstruction with Marlex and stainless-steel mesh during a median follow-up period of 56 months. Conclusions Wide resection of sternal tumors provides good local control. Reconstruction with Marlex and stainless-steel mesh seems to be the most effective technique for repairing a wide anterior chest wall defect.     

Resection of Sternal Metastasis from Endometrial Carcinoma Followed by Reconstruction with Sandwiched Marlex and Stainless Steel Mesh: Report of a Case

We report the successful resection of sternal metastasis from endometrial carcinoma, followed by reconstruction of the chest defect, in an 87-year-old woman. We performed subtotal sternectomy and concurrent resection of the ribs and overlying soft tissue. The skeletal defect was then reconstructed with sandwiched Marlex and stainless steel mesh, and soft tissue coverage was accomplished by using a pectoralis major advancement flap. The patient had an uneventful postoperative course with no sign of recurrence during 5 years of follow-up. Thus, reconstruction with Marlex and stainless steel mesh could be an effective technique for preventing paradoxical movement of the thorax and protecting the intrathoracic organs.     

Reconstruction of large anterior full-thickness defect in the chest wall after resection of chondrosarcoma

Radical removal of a chondrosarcoma resulted in a very large full-thickness defect of the anterior chest wall, including the body of the sternum and adjacent parts of the ribs on both sides. The defect was closed with a double layer of Marlex mesh supported by metal bars bridging the gaps between the ends of resected ribs. This prosthesis was covered with bilateral latissimus dorsi muscle flaps and a split-thickness skin graft. The result, from both the functional and the cosmetic points of view, was excellent. The method permits closure of very large chest wall defects, enabling extensive radical removal of malignant tumours to prevent local recurrence.     

胸壁肿瘤切除与重建方法探讨

目的探讨胸壁肿瘤切除及胸壁缺损修补重建的方法。方法回顾性分析7例胸壁肿瘤患者的临床资料,其中肋骨分化型软骨肉瘤、肋骨分化型骨肉瘤、肋骨骨巨细胞瘤及肋骨骨旁骨肉瘤各1例,肺癌胸壁转移癌2例,乳腺癌复发胸壁转移1例。行扩大根治切除4例,姑息性切除2例,限制性切除1例。切除肋骨1-3根,胸壁骨性缺损面积（4 cm×15 cm）-（15 cm×15 cm）。胸壁缺损重建6例：用部分膈肌修补加固下胸壁缺损1例,应用钢丝支架并腹壁转移肌皮瓣修补缺损1例,应用M arlex网片修补骨性缺损并同时覆盖周围肌肉瓣4例。1例限制性切除患者仅行拉拢缝合,未行胸壁重建。结果应用双层M arlex网片修补骨性缺损并同时覆盖周围肌肉瓣的3例术后胸壁稳定性满意,限制性切除的1例胸壁外观正常,余3例均出现反常呼吸。术后随访6例,时间5月-6年,4例原发性肋骨肿瘤患者均健在,3例转移癌患者死亡1例,失访1例,健在1例。结论依据胸壁缺损的位置和大小,应用双层聚丙烯网片结合自体肌肉瓣覆盖是修补重建胸壁的可靠方法 。     

A case report of chest wall reconstruction utilizing microvascular surgery

A 62-year-old man underwent left chest wall reconstruction after resection of the chest wall including 4-6th ribs for the metastatic tumor of squamous cell carcinoma of the left lung. The chest wall defect measuring 15 x 10 cm was reconstructed with double Marlex mesh in skeletal chest and covered with pedicled free mucocutaneous flap of tensor fasciae latae which was implanted by the vascular anastomoses to the thoracodorsal artery and vein using microvascular surgical technique. The flap was attached well and its blood supply was excellent on postoperative angiography.