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。     

胸壁肿瘤切除后胸壁缺损的修复

目的探讨胸壁肿瘤切除后胸壁缺损的修复方法。方法 2011年5月至2018年5月共收治胸壁肿瘤患者31例,其中原发胸壁良性肿瘤6例,原发胸壁恶性肿瘤14例,转移性胸壁恶性肿瘤11例。胸壁缺损类型包括单纯骨性缺损16例,单纯软组织缺损4例,全层缺损11例。骨性胸壁缺损采用补片(7例)、Prolene网片(3例)、网格状钛合金钢板(17例)进行重建。胸壁软组织缺损采用直接对拢缝合(11例)、皮瓣修复(20例)。结果本组患者均顺利完成手术,术后呼吸功能良好,无反常呼吸运动。2例带蒂背阔肌肌皮瓣边缘部分坏死,1例带蒂腹直肌肌皮瓣远端部分坏死,1例游离腹壁下动脉穿支皮瓣边缘部分坏死,经换药后伤口均愈合。结论外科手术是胸壁肿瘤治疗的主要方法,术后的胸壁缺损按照大小、位置和复杂程度选择合适的材料进行修复,重建胸壁结构的稳定性及密闭性,是手术成功的关键。     

胸壁巨大肿瘤切除与修复重建

目的 探索胸壁巨大肿瘤切除与修复重建的方法及疗效。方法 回顾性分析2015年7月至2020年1月收治的4例胸壁巨大肿瘤的患者资料,其中软骨肉瘤2例,骨巨细胞瘤1例,乳腺癌转移1例。所有病例行肿瘤扩大切除,肿瘤切除后胸腔外露,2例采用补片+钛网重建,切口直接闭合,1例采用补片+背阔肌皮瓣修复创面,1例采用补片+钛网+背阔肌皮瓣重建。结果 1例患者术后切口感染经清创后好转。所有患者随访2～6年,均未见肿瘤复发及转移。无反常呼吸,无呼吸困难等不适。结论 胸壁巨大肿瘤切除困难,选择补片加钛网的重建方式更为合理安全,选择背阔肌皮瓣修复软组织缺损可取得良好效果。注重围手术期管理、多学科参与可使患者取得更好的疗效。     

可扩张乳房假体加背阔肌肌皮瓣的乳房再造术

目的：报告应用带蒂背阔肌肌皮瓣转移术及可扩张的乳房假体（BECKER）置入,修复乳腺癌根治术后的胸壁畸形,同时再造乳房的手术方法。方法：根据乳腺癌病灶清除术后患者胸部的畸形状况,设计患侧带蒂背阔肌肌皮瓣的肌瓣长度、体积以及皮瓣的面积和形状,切取肌皮瓣后经腋部皮下隧道转移至胸前。用肌瓣修复胸前软组织缺损,皮瓣则用于弥补胸部皮肤的不足。肌瓣与胸壁间置入可扩张的乳房假体。术后经注射壶注水,逐步扩张至额定值。6个月后,可抽除注射壶并重建乳头,完成治疗。结果：自1999年以来,对各种乳腺癌术后患者行乳房再造术共26例,获得了满意效果。结论：应用带蒂背阔肌肌皮瓣转移术及可扩张的乳房假体置入,不仅可修复乳腺癌病灶清除术后的胸部软组织的缺损、锁骨下的凹陷畸形而且可重建乳房。该法具有创伤小、恢复快、再造乳房的外形及质感逼真等特点。     

应用背阔肌皮瓣修复足部大面积皮肤软组织缺损

目的 报道应用背阔肌皮瓣修复足部大面积皮肤软组织缺损的临床效果.方法 应用带血管、神经蒂的背阔肌游离皮瓣移植修复足部大面积皮肤软组织缺损8例,切取背阔肌皮瓣面积最大25 cm×20 cm,最小12 cm×10 cm.结果 术后8例皮瓣全部成活,术后经1～6年随访,足部功能恢复较好,皮肤无破损,感觉部分恢复.结论 背阔肌皮瓣部位隐蔽,血供丰富,切取范围大,适合修复足部大面积皮肤软组织缺损,有助于足部功能的重建,是一种较为理想的治疗方法.     

六例巨大胸壁缺损的修复

目的 探讨巨大胸壁缺损的修复方法.方法 2005年10月至2009年6月,为6例患者进行巨大胸壁缺损的修复,其中背阔肌肌皮瓣加钛网1例,逆行背阔肌肌皮瓣加聚丙烯网片和涤纶补片1例,游离股前外侧皮瓣1例,双侧胸大肌肌瓣1例,纵行腹直肌肌皮瓣2例.结果 随访1～24个月,皮瓣100%覆盖创面、皮瓣100%成活、心肺功能没有影响、外观满意;并发症:胸壁瘘管1例,胸壁窦道1例经再次清创愈合.结论 巨大胸壁缺损需要分层修复,胸廓缺损可以用鈦网或聚丙烯网片修补,软组织缺损根据部位、大小和范围及周围组织情况,选择不同的修复方法.背阔肌肌皮瓣组织量大、旋转弧度大、血供恒定、容易切取,可作为首选,胸大肌肌瓣、纵行腹直肌肌皮瓣或游离的股前外侧皮瓣,根据实际情况灵活掌握.     

应用背阔肌皮瓣修复足部大面积皮肤软组织缺损

目的 报道应用背阔肌皮瓣修复足部大面积皮肤软组织缺损的临床效果.方法 应用带血管、神经蒂的背阔肌游离皮瓣移植修复足部大面积皮肤软组织缺损8例,切取背阔肌皮瓣面积最大25 cm×20 cm,最小12 cm×10 cm.结果 术后8例皮瓣全部成活,术后经1～6年随访,足部功能恢复较好,皮肤无破损,感觉部分恢复.结论 背阔肌皮瓣部位隐蔽,血供丰富,切取范围大,适合修复足部大面积皮肤软组织缺损,有助于足部功能的重建,是一种较为理想的治疗方法.     

应用背阔肌皮瓣修复足部大面积皮肤软组织缺损

目的 报道应用背阔肌皮瓣修复足部大面积皮肤软组织缺损的临床效果.方法 应用带血管、神经蒂的背阔肌游离皮瓣移植修复足部大面积皮肤软组织缺损8例,切取背阔肌皮瓣面积最大25 cm×20 cm,最小12 cm×10 cm.结果 术后8例皮瓣全部成活,术后经1～6年随访,足部功能恢复较好,皮肤无破损,感觉部分恢复.结论 背阔肌皮瓣部位隐蔽,血供丰富,切取范围大,适合修复足部大面积皮肤软组织缺损,有助于足部功能的重建,是一种较为理想的治疗方法.     

应用背阔肌皮瓣修复足部大面积皮肤软组织缺损

目的 报道应用背阔肌皮瓣修复足部大面积皮肤软组织缺损的临床效果.方法 应用带血管、神经蒂的背阔肌游离皮瓣移植修复足部大面积皮肤软组织缺损8例,切取背阔肌皮瓣面积最大25 cm×20 cm,最小12 cm×10 cm.结果 术后8例皮瓣全部成活,术后经1～6年随访,足部功能恢复较好,皮肤无破损,感觉部分恢复.结论 背阔肌皮瓣部位隐蔽,血供丰富,切取范围大,适合修复足部大面积皮肤软组织缺损,有助于足部功能的重建,是一种较为理想的治疗方法.     

应用背阔肌皮瓣修复足部大面积皮肤软组织缺损

目的 报道应用背阔肌皮瓣修复足部大面积皮肤软组织缺损的临床效果.方法 应用带血管、神经蒂的背阔肌游离皮瓣移植修复足部大面积皮肤软组织缺损8例,切取背阔肌皮瓣面积最大25 cm×20 cm,最小12 cm×10 cm.结果 术后8例皮瓣全部成活,术后经1～6年随访,足部功能恢复较好,皮肤无破损,感觉部分恢复.结论 背阔肌皮瓣部位隐蔽,血供丰富,切取范围大,适合修复足部大面积皮肤软组织缺损,有助于足部功能的重建,是一种较为理想的治疗方法.     

Large Chest Wall Reconstruction Using Titanium Micromesh and a Pedicled Latissimus Dorsi Musculocutaneous Flap: Report of a Case

The patient was a 54-year-old woman with a dermatopleural fistula and necrosis of the third to the fifth anterior ribs after postoperative adjuvant radiation for right breast cancer. After resection of the chest wall and combined partial resection of the right upper and middle lobes of the lung, the thoracic cage defect was stabilized by titanium micromesh and the soft tissue defect was covered by an ipsilateral pedicled latissimus dorsi musculocutaneous flap. The dorsal skin defect was covered by split-thickness skin grafts 3 weeks later. The advantages of titanium micromesh lie not only in its good biocompatibility and mechanical strength, but also in its light weight and low radiological interference. No paradoxical movement or other prosthesis-related complications occurred during the follow-up period. Thus, we consider that titanium micromesh is a suitable material to use in the reconstruction of a large chest wall defect.     

慢性胸壁放射性溃疡的分期修复

目的探讨慢性胸部放射性溃疡缺损的修复方法。方法自2010年4月至2013年6月,对10例胸部慢性溃疡患者实行分期治疗。Ⅰ期清创,大网膜填塞;Ⅱ期行皮瓣转移修复创面,包括背阔肌带蒂移植及胸大肌肌皮瓣转移。术后观察手术疗效及并发症情况。结果术后随访26~37个月,平均随访25个月。所有患者无手术死亡,转移皮瓣无一例发生坏死。1例患者术后出现皮下积液,经抽液后加压包扎痊愈。其余患者无术后感染情况发生。患者术后呼吸功能良好,无反常呼吸运动。结论对于慢性溃疡的修复,分期治疗可取得较好的临床治疗效果。大网膜瓣适用于软组织缺损的充填,尤其是感染性软组织缺损。     

Full thickness chest wall reconstruction after tumor resection by myocutaneous flap

Full thickness chest wall defects result when a chest wall tumor resection is necessary. The feasibility of a reconstruction is sometimes unfamiliar to the oncologist or thoracic surgeon; this can be the reason for refusing the possibility of surgical resection or inappropriate coverage of the defect. Our experiences over the last 7 years in collaboration between plastic the thoracic surgical services, shows that it is generally possible to utilize a myocutaneous flap for reconstruction of even extensive full thickness chest wall defects. The reconstruction of any full thickness chest wall defect after tumor resection by myocutaneous flaps is almost always possible with low mortality, acceptable morbidity and good results, mechanically and aesthetically. The experience with the different reconstruction techniques clearly shows the preference for the latissimus dorsi myocutaneous flap, but also emphazises that the other kinds of reconstruction must be kept in mind for special indications.     

Clinical studies on reconstruction procedure of total layer chest wall resection

The results of clinical studies on 16 reconstruction procedure after total layer chest wall resection in 14 cases of malignant tumor of the chest wall were reported. The 14 cases consisted of two cases with recurrent primary chest wall tumor, two cases of primary breast cancer, seven cases of recurrent breast cancer, and others. The reconstruction procedure after total layer chest wall resection was conducted using only various myocutaneous flaps (eight cases using latissimus dorsi of the resected side, three cases using the abdominitis of the resected side, three cases using latissimus dorsi of the non-resected side, and two cases using a pectoralis major myocutaneous flap of the non-resected side). reconstruction only using a myocutaneous flap proved to be satisfactory for preventing early stage postoperative respiratory distress and maintaining the stability of the chest wall and respiratory function during prolonged observation. Namely, use of myocutaneous flap is the best approach of reconstruction the chest wall after total layer chest wall resection. We confirmed that reconstruction with latissimus dorsi myocutaneous free flap of the non-resected side with microvascular anastomosis of thoracodorsal vessels was useful for posterior chest wall tumors invading the latissimus dorsi muscle. Also, our results demonstrated the insertion of an omental flap under the myocutaneous flap was useful for cases with secondary chest wall infection or vascular damage caused by preoperative high dose irradiation.     

Reconstruction of chest wall using myocutaneous flap

Reconstruction of chest wall using myocutaneous flap has been performed in 2 cases. A 72-year-old female referred to our hospital for locally recurrent left breast cancer without any distant metastases. The other patient was a 77-year-old female, having locally recurrent liposarcoma of the left lateral chest wall. Chest wall was resected with wide margin of normal tissue, and myocutaneous flaps of latissimus dorsi were used for reconstruction of skin defect (13 x 8 cm and 14 x 10 cm) in both cases. Although additional split-thickness skin graft was required for one of them, myocutaneous flaps were useful for the reconstruction of widely defected chest wall. By using this technique, wider margin can be obtained, which could decrease the risk for local recurrence of malignant tumor.     

胸壁肿瘤切除后的一期修复重建

目的 观察胸壁肿瘤切除术后胸壁缺损一期修复重建的临床效果。方法 1998年1月～2003年3月外科治疗胸壁肿瘤31例。男20例，女11例。年龄8～72岁。原发性胸壁肿瘤21例，肺癌侵犯胸壁6例，乳腺癌术后复发2例，放射性坏死和皮肤癌各1例。切除肋骨2～7根，平均3．6根。缺损面积20～220cm^2，平均97．1cm^2。合并肺切除10例，部分膈肌切除2例，胸骨下段切除1例。单纯软组织修复7例(背阔肌 大网膜，背阔肌肌皮瓣，背阔肌肌瓣)，单纯骨性重建5例(涤纶布或Prolene网)，骨性合并软组织修复19例(背阔肌、胸大肌、背阔肌 阔筋膜或大网膜，与涤纶布或Prolene网修复)。结果 术后发生并发症3例(9．7％)，其中切口感染1例，软组织与修复物之间积液2例。无手术死亡。26例获5～57个月随访，术后生存时间6～57个月，中位生存时间22个月。结论 胸壁肿瘤切除术后造成的巨大缺损，采用胸壁修复重建术可获得良好的临床效果。     

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.     

Resection and reconstruction of sternnum

In case of sternal resection, it is necessary to preserve bone material indispensable for the stability of the anterior chest wall and air tightness of the thoracic cavity, and the support of the chest wall integrity must be restored by some means. Various techniques have been applied to the reconstruction of the chest wall following resection. During the last 10 yers, we have performed reconstructive operation for 6 cases of the chest wall following resection of the sternum in recurrent cases of breast cancer or invaded case of primary breast cancer. In these patients, the chest wall was reconstructed using a rib-latissimus dorsi osteomyocutaneolus flap or a latissimus dorsi myocutaneous flap. The sternum was totally resected in 3 cases, and in all 3 cases, reconstructed using a rib-latissimus dorsi osteomyocutaneous flap. Although postoperative pulmonary function decreased, all cases could be relieved from endotracheal intubation within 17 hours aftr operation, and had no problems in activities of daily living or occurrence of chest flailing or paradoxical movement of the chest. An artificial material (expanded polytetrafluoroethlene patch) was used in only one patient for the reconstruction of the osseous thorax, but this case developed infection during postoperative chemotherapy. After this experience, we used only biological materials for the reconstruction of the chest wall and postoperatively performed radiotherapy and/or chemotherapy on all cases. We have observed no flap infection or detachment since then. One characteristic of using the latissimus dorsi myocutaneous flap is that it is easily elevated and rarely causes serious postoperative esthetic or functional problems. The flap is also easily utilized to reinforce the osseous thorax because ribs immediately below the latissimus dorsi muscle are readily mobilized as a pedicle graft. Reconstruction of the chest wall following resection of the sternum, described in this report, allowed us to perform radiotherapy and/or chemotherapy without serious postoperative complications on the cases relapsing after treatment of breast cance. The 2-year survival rate is 50% and one of these cases survived up to 10 years after resection of the sternum. Thus we prefer to perform resection of the sternum for sternal recurrence of breast cancerif there are no metastatic lesions in other organs.     

Poland's Syndrome: Improved Surgical Management

Single-stage reconstruction of the chest wall combined with simultaneous augmentation mammoplasty and transfer of an island pedicle myocutaneous flap of latissimus dorsi muscle are major improvements over previous multiple-stage procedures that provide less satisfactory cosmetic results in management of patients with Poland's syndrome. Utilization of the single-stage technique in 2 patients demonstrated its efficacy as proven by excellent cosmetic results. In 1 patient with absent second, third, and fourth costal cartilages and ribs, Marlex mesh covered with a synthetic dura mater graft was employed to stabilize the chest wall. Simultaneously, an island pedicle myocutaneous flap of latissimus dorsi with its neurovascular bundle preserved was transferred to cover the prosthesis. The other patient had a coexistent pectus carinatum defect, which was repaired by resection of the costal cartilages and osteotomy of the sternum without use of Marlex. The breast implant was covered concomitantly with the myocutaneous flap of latissimus dorsi. No morbidity or mortality occurred. The cosmetic and functional results are superior to those obtained with standard techniques.     

Immediate reconstruction of chest and abdominal wall defect following high voltage electrical injury

The report describes a postelectrical burn lateral chest wall and ipsilateral upper abdominal wall defect, successfully managed by immediate adequate debridement and use of a latissimus dorsi myocutaneous flap.