Osteosynthetic thoracic stabilization after complete resection of the sternum.

We present a case of a 66-year-old diabetic patient with chronic non-healing sternum after CABG operation. After four attempts of sternum refixation within 2 years, the need of bone debridement resulted in a nearly complete loss of sternum. Finally, a mesh graft and a pectoralis muscle flap were used to bridge the sternal space. Despite good wound healing, the thoracic instability led to intolerable chest pain persisting over the next years. In this case report, we describe the successful thoracic stabilization by using transverse plate fixation, which resulted in perfect thoracic stabilization and immediate cessation of pain.     

恶性肿瘤切除后巨大腹壁缺损的修复

目的 探讨原发于腹壁或侵犯腹壁的恶性肿瘤切除术后巨大腹壁缺损的修复方法 .方法 本组20例,腹壁恶性肿瘤12例,其中腹壁横纹肌肉瘤9例、恶性纤维组织细胞瘤3例;腹膜后及腹腔恶性肿瘤侵犯腹壁8例,其中腹膜后恶性肿瘤3例、横结肠癌1例、升结肠癌右半结肠切除术后2～3年局部复发3例、肾癌术后5年腹壁种植复发1例.采用自膨式聚丙烯和膨化聚四氟乙烯复合补片行修复手术.观察术后并发症、修复成功率.结果 术后一期愈合20例,无皮下积液,无切口感染、裂开和切口疝发生,未见修补材料与肠管粘连,修复成功率100%.随访20例,随访时间6～18个月,平均随访(9.3±3.4)个月.补片与腹壁相容性良好,无局部炎症反应;均未发现材料与肠管粘连,无切口疝形成,腹壁修补区未见肿瘤复发.结论 自膨式聚丙烯和膨化聚四氟乙烯复合补片具有抗张力强度大、良好的组织相容性、修补术后并发症少等特点,是一种良好的肿瘤切除后腹壁缺损修复材料.     

Use of pedicled greater omental flap to repair a thoraco-abdominal defect after extensive tumor resection

Resection of longstanding chest or abdominal wall malignancies can create extensive defects. Pedicled or free myocutaneous flaps [3–6, 8, 9, 12, 14–17] are often the choice for reconstruction. The omental flap, however, is a valid alternative [1, 2, 8, 19, 22]. A case is reported in which the omental flap was used to cover the defect resulting from the resection of an extensive basal cell carcinoma of the lateral thorax and abdominal wall. Fibrosis and calcification of the omentum lead to a stable abdominal wall without the use of synthetic mesh [20, 23]. Received: 3 January 2000 / Accepted: 10 July 2000     

腹壁肿瘤切除术后巨大/超大腹壁缺损的外科修复重建策略

腹壁肿瘤、尤其是恶性肿瘤R0切除术后会导致巨大、甚至超大腹壁缺损,选择合理的腹壁修复重建技术是治疗关键。本文总结了腹壁恶性肿瘤的临床特点、治疗现状、肿瘤扩大切除后腹壁缺损的术前评估和腹壁缺损修复重建的术式选择;重点阐释了腹壁缺损类型、缺损大小、缺损周围组织情况和患者全身情况对术式选择的重要性。     

An inexpensive reconstruction method after resection in tumors of the proximal humerus with extensive involvement of the diaphysis

Limb salvage is now the norm for a large majority of malignant bone tumors. The proximal humerus is the third most common site for the occurrence of malignant tumors of bone. In tumors of the proximal humerus with large volume disease, extensive involvement of the diaphysis is not infrequent. Resection may often extend as far as the distal metaphysis in order to obtain adequate oncologic margins. A very small distal stump of bone poses unique challenges in reconstruction where conventional reconstruction modalities may be difficult to apply. We describe the use of a customised plate to reconstruct these defects which offers an inexpensive, easy to use, durable reconstruction option. It provides adequate shoulder and arm stability and ensures excellent hand and elbow motion with good functional results.     

Kidney function after extensive resection of the intestine]

Experimentally on 52 dogs and clinically in 46 patients it was found that extensive enterectomy of the distal small intestine, in particular, would induce alterations in the renal function and grave disorders in kalium metabolism. In treatment of patients subjected to extensive enterectomy, it is recommended to use the therapeutic complex contributing not only to rehabilitation of the digestive function but also to normalization of the renal activity and blood water-electrolyte content, special attention being attached to a correction of kalium metabolism.     

Benign tumors of right atrium necessitating extensive resection and reconstruction

Two patients with gigantic benign right atrial tumors were successfully treated at New York University Medical Center. Both patients required extensive resection and reconstruction for cure. Although these tumors are rare, thorough exploration employing cardiopulmonary bypass is required before an appraisal of resectability can be made. Reconstruction can be readily accomplished with autologous pericardium and thereby provides an opportunity for cure of these unusual and rare lesions.     

Immunologic parameters of blood after extensive intestinal resection

A complex clinico-immunological examination of patients subjected to extensive resections of different portions of the intestine was performed. It was established that participation of the immune system in regulation of homeostasis in patients under examination was characterized by lympho- and monocytopenia, lower amount of T-lymphocytes at the expense of low avidity fractions with a simultaneous increase of high avidity fractions of these cells.     

应用游离腓骨组织瓣修复口腔肿瘤切除后下颌骨缺损

目的探讨应用游离腓骨组织瓣修复口腔肿瘤切除后下颌骨缺损的临床疗效。方法回顾分析接受游离腓骨组织瓣修复口腔肿瘤切除后下颌骨缺损的临床资料15例。其中下颌骨造釉细胞瘤5例，下颌骨纤维肉瘤2例。颌下腺腺样囊性癌3例，颌下腺粘液表皮样癌2例，口底黏膜高分化鳞癌3例。单纯腓骨骨瓣修复10例，腓骨骨皮瓣修复5例。结果14例腓骨瓣成活，生长良好，1例腓骨骨皮瓣因术后发生血循环危象，经抢救无效而坏死。结论游离腓骨组织瓣修复口腔肿瘤切除后下颌骨缺损可较好地恢复容貌和口腔功能，提高了患者的生存质量。     

Proceed补片对腹壁硬纤维瘤切除后遗留巨大腹壁缺损修补的疗效分析

目的探讨Proceed网片对腹壁缺损修补的疗效。方法回顾性分析了我院2年来对15例硬纤维瘤患者以Proceed补片进行腹壁缺损修补的手术方法及随访资料。结果术后3例发生皮下积液,全部患者随访1个月~2年,无感染、切口疝发生,无局部不适。结论Proceed补片具有抗粘连、复发率低等优点,可在腹壁硬纤维瘤切除术后遗留巨大腹壁缺损修补中加以应用。     

Predicting nutritional outcome after extensive small bowel resection

Introduction:  Extensive small bowel resection often results in the need for long-term nutritional support. This study aimed to assess the factors affecting long term nutritional outcome following extensive small bowel resection.
Method:  Patients who underwent extreme small bowel resection were assessed. Indication for small bowel resection, length of remaining small bowel, presence of ileocaecal valve, colonic resection and long term total parental nutritional (TPN) requirements were recorded.
Results:  There were 24 patients of age range 28–79 (median 49 years). Fourteen were male. Indications for small bowel resection included Inflammatory bowel disease ( n  = 13) Mesenteric ischemia ( n  = 8) and miscellaneous ( n  = 3). Patients were divided into three groups:
Conclusion:  Small bowel resection leaving <100 cm of small bowel is associated with a 70% chance of needing long-term TPN. Presence of ileocaecal valve and/or some colon reduces the risk of long term TPN.