皮瓣修复胸壁大块组织切除后缺损

由于大多数胸壁恶性肿瘤对放射治疗不敏感,故应采用较广泛的手术切除术。切除范围包括胸壁软组织及肿瘤下相邻有关的肋骨和胸骨。必要时还应做好胸膜或肺组织切除的准备。位于胸骨柄的肿瘤,除胸骨外,还须切除双侧胸锁关节及部份锁骨。因切除范围较广,造成胸壁的缺损也较大,如何重建胸壁,修复缺损是一较困难的问题。 1975～1978年,我们对5例胸壁恶性肿瘤,行大块组织切除后的创面采用中厚皮片移植修复2例;用局部带蒂皮瓣转移进行修复3例。初步认为后者有一定的优点,但由于病例还少,尚需进一步观察。     

同种异体胸骨移植1例报告

胸骨肿瘤尤其是恶性或巨大的肿瘤,行胸骨和肋骨广泛切除后,缺损的大块胸壁需进行重建。重建的方法有多种,生物材料中自体组织仅能用于小的胸骨缺损［１］。应用同种异体胸骨移植来修复缺损国内仅偶见报道［２,３］。我院１９９６年８月对１例胸骨巨大骨化性纤维瘤的患...     

自体髂骨移植在原发性胸骨肿瘤胸廓重建的临床应用

原发性胸骨肿瘤临床少见,仅占胸壁肿瘤的10％,多发生在胸骨柄,其次是胸骨体,发生于剑突者甚少,且几乎均为恶性。其治疗应以手术切除为主,术后胸前区的巨大缺损应行胸廓重建,重建的方法及选用材料很多,并各有优缺点。自2002—01—2009—06,我们共对6例原发性胸骨肿瘤病例采用自体髂骨移植重建胸廓,取得了较好的效果。     

生物材料人工胸壁重建犬胸壁骨性缺损

目的 构建生物材料人工胸壁并重建犬巨大胸壁骨性缺损,对照传统的"三明治"重建法来探讨人工胸壁重建胸壁骨性缺损的可行性和有效性.方法 (1)对猪膜性及骨性材料进行组织处理及表面改性,制备出人工胸膜及人工肋骨并构建成人工胸壁用于术中重建.(2)以中国杂种犬5只制备成胸壁巨大缺损模型(缺损>5 cm×5 cm).(3)实验组3只以生物材料人工胸壁进行修复重建,对照组2只采用传统的"三明治"法修复,随访观察两组术后3,6,12个月的重建效果及置入后的排斥反应.结果 实验组3只犬围术期及术后随访12个月均存活,未见植入后排斥反应,重建后的胸壁外形正常,修复重建区域无塌陷,胸廓活动度好,未见反常呼吸.术后3,6,12,24个月X线检查显示重建后胸廓完整性良好,无变型,人工肋骨对位好且无移位,未见胸壁反常运动.对照组2只术后随访见重建处胸壁外形尚正常,局部有轻微塌陷,无明显反常呼吸.胸部X线检查显示"三明治"中的骨水泥移植体不透X线,且随呼吸有轻度的反常运动.各组术后血常规及免疫球蛋白5项均未见异常.结论 生物材料人工胸壁重建犬胸壁骨性缺损安全、有效,无急性及慢性排斥反应发生,修复重建效果良好.     

胸壁大块缺损的重建

胸壁大块缺损的重建王庭阁陈绪发本院自１９８６年３月～１９９０年５月共收治７例胸壁大块缺损，采用涤纶布代替胸膜、克氏针和钢丝代替胸骨和肋骨并用带蒂的胸大肌或／和背阔肌重建胸壁，收到了满意的效果．现报告如下．临床资料本组７例，男５例，女２例；年龄２１～５...     

带肋骨胸大肌肌皮瓣与腓骨(皮)瓣修复重建下颌骨疗效对比分析

目的通过对带肋骨胸大肌肌皮瓣与腓骨(皮)瓣修复重建下颌骨形态及功能的临床疗效进行随访对比分析，提供修复重建下颌骨的临床治疗方法和选择依据。方法19例下颌骨缺损分为两组。组Ⅰ：带肋骨胸大肌肌皮瓣修复重建下颌骨8例，其中创伤6例，肿瘤2例；组Ⅱ：腓骨(皮)瓣修复重建下颌骨11例，其中创伤7例，肿瘤4例。术后6，12，24，36个月随访观察、对比分析、评价下颌骨形态及功能恢复情况。结果接受带肋骨胸大肌肌皮瓣与腓骨(皮)瓣方法修复重建下颌骨的19例患者术后随访观察、对比分析、评价结果显示，对下颌骨形态恢复比较，两种方法差异无统计学意义，对下颌骨功能恢复比较，两种方法差异有统计学意义。结论带肋骨胸大肌肌皮瓣与腓骨(皮)瓣修复重建下颌骨形态方面有一致的临床疗效；腓骨(皮)瓣对下颌骨功能重建的临床疗效优于带肋骨胸大肌肌皮瓣。     

胸大肌肌皮瓣在晚期头颈肿瘤手术缺损重建中的应用

目的总结胸大肌肌皮瓣在晚期头颈肿瘤手术缺损重建中的应用。方法回顾性总结1988年1月1日-2003年12月31日14例在我科因头颈部肿瘤手术后巨大组织缺损应用胸大肌肌皮瓣进行修复的临床资料。结果肌皮瓣全部成活13例，1例肌皮瓣远端部分坏死，经换药后愈合。1例与受区组织伤口部分裂开，换药处理后愈合；1例胸部皮下积液，经穿刺抽液后消失。成活胸大肌肌皮瓣色泽良好，但多显有些臃肿。结论胸大肌肌皮瓣是一种非常实用而优良的修复材料。它具有丰富的组织量，优良的血液供应，且与头颈部邻近，在多种情况下可以应用，特别适用于头颈部肿瘤扩大切除术后缺损的即刻修复重建。     

记忆合金环抱器在胸壁毁损的胸壁重建修复中的应用

目的 探讨应用镍钛记忆合金环抱器在胸壁毁损中胸壁重建的方法和疗效。方法2007年1月～2009年1月对6例局部胸壁毁损伤患者采用镍钛记忆合金环抱器固定节段性及粉碎性肋骨骨折,恢复肋骨连续性,完成骨性胸廓重建,利用胸大肌、背阔肌、大网膜修复软组织治疗胸壁毁损伤。结果全组无手术死亡及严重并发症,恢复了胸壁稳定性。结论镍钛记忆合金环抱器在胸壁创伤修复中,具有使用方便、操作简单、疗效确切,值得推广应用。     

晚期喉癌喉功能保留手术的研究

目的探讨晚期（T3及T4）喉癌保留喉功能手术的可行性和喉重建方法,提高晚期喉癌患者的生存质量。方法对行手术治疗103例晚期喉癌患者进行回顾分析。按2002年UICC修订方案分期,Ⅲ期57例,Ⅳ期46例。根据病变不同,采取以下几种方式进行手术治疗：喉垂直部分切除术;垂直侧前位喉次全切除;喉声门上水平部分切除术;喉声门上水平垂直部分切除术;喉环状软骨上部分切除一环舌骨吻合术;Pearson＇s（黏膜发音管成形）术。以胸骨舌骨肌筋膜瓣、胸骨舌骨肌软骨膜瓣、胸锁乳突肌瓣、颈阔肌肌皮瓣、双蒂接力肌甲状软骨膜瓣、甲状软骨膜瓣、舌骨肌瓣、会厌瓣以及胸大肌肌皮瓣等修复喉腔组织缺损,重建喉功能。采用直接法计算生存率及肿瘤复发趋势。结果全组患者3、5年生存率分别为76．70％和64．08％。3、5年肿瘤复发率为11．83％和14．08％。拔管率为79．61％（82／103）。所有患者均可发声以及经口进食,无吞咽困难及呛咳。结论晚期喉癌根据手术适应证．选择适当术式以及修复方法,选择性施行喉功能保留手术是可行的,可提高晚期喉癌患者的生存质量。     

胸骨正中切口术后感染与慢性胸骨骨髓炎扩创后的重建

扼要复习胸骨正中切口感染的病理及发展,侧重讨论胸骨扩创与扩创后的重建问题。介绍了用腹直肌瓣结合胸大肌移植,重建胸骨扩创术后残余缺损的手术步骤。     

Use of Marlex mesh with methylmethacrylate to repair large full-thickness defects after subtotal sternectomy caused by chondroma

BACKGROUND: Sternal benign neoplasms are extremely rare. Chondroma is a benign tumor of cartilage and can be single or multple. CASE REPORT: We presented a case of 28-year-old woman with chondroma of the sternum treated by "en bloc" resection of the tumor (subtotal sternectomy). The chest wall defect was repaired by the placement of Marlex mesh and metylmethacrylate ("sandwich method") for stabilization of the thoracic wall. This place was covered with pectoralis major muscle and skin. The postoperative course was uneventful and the wounds healed by primary intention. CONCLUSION:. The functional and cosmetic results in the usage of Marlex mesh with metylmethacrylate to repair a large full-thickness defect after subtotal sternectomy caused by chondroma were good and the patient was able to resume her preoperative level of activity.     

Reconstruction of the sternum and chest wall with methyl methacrylate: CT and MRI appearance

The aim of our study was to define the appearance of methyl methacrylate grafts replacing resected sternum and ribs on CT and MRI and how the sternal graft may mimic an abnormally sclerotic sternum on CT images. We reviewed the CT scans of nine patients who had undergone chest wall resection (eight with malignant and one with benign disease) and reconstruction with a composite of methyl methacrylate and Marlex mesh graft. One of them had an MRI study as well. The size, shape and CT attenuation were assessed on mediastinal and bone window settings. The sternal graft was seen on mediastinal and even better on bone windows as an abnormally wide, irregularly shaped structure, somewhat denser than the normal sternum. The chest wall prosthesis replacing resected ribs was seen as a continuous dense structure and of similar attenuation as that of the sternal graft. On MRI the prosthesis appeared as a well-defined structure with no signal. Reconstruction of the chest wall with methyl methacrylate appears on CT as a diffusely dense sclerotic bone lesion not unlike a malignant lesion. The possibility of a graft has to be included in the differential diagnosis in these cases. Received 8 January 1997; Revision received 23 May 1997; Accepted 4 July 1997     

Computed tomography of pectoral flaps

We report two cases of rotated pectoral flaps performed following sternal debridement. The key to the diagnosis is recognition that the characteristic central area of low density represents fat and not fluid. This, along with the finding of sharply defined fascial planes and an absence of one or both pectoralis major muscles, should allow confident differentiation between this entity and a postoperative chest wall abscess.     

颞骨次全或扩大切除术后局部缺损的修复

目的 探讨颞骨次全或扩大切除术后局部缺损的最佳修复方法。 方法 回顾分析1993年7月2003年6月共33例颞骨次全/扩大切除术后局部缺损的修复情况。结果,33例患者,其中恶性26例,良性7例,病变范围广,颞骨次全切除22例,扩大切除11例。移植组织充填修复33例次,各种修复总存活率为81.8%（27/33）,其中胸大肌带蒂岛状皮瓣77.8%（7/9）,带蒂颞肌瓣转移100%（9/9）,颞肌瓣加胸锁乳突肌/斜方肌皮瓣100%（4/4）,胸锁乳突肌上段60.0%（3/5）,脂肪充填66.7%（4/6）。病变性质,累及颅内外、术前放疗、复发、术后脑脊液漏是影响修复愈合的因素。结论 修复方法根据病变性质,缺损大小,局部血循环情况以及上述影响因素而定。局部缺损小,良性病变,首选游离脂肪充填（带真皮更佳）,如为恶性首选带蒂颞肌瓣。组织缺损多,血运欠佳时考虑应用胸大肌带蒂岛状皮瓣。多次修复失败者应采用游离植皮覆盖创面。     

Radical resection of giant chondrosarcoma of the anterior chest wall

BACKGROUND: Chondrosarcomas represent approximately 30% of primary malignant bone tumors, the most frequent of which is on anterior thoracic wall. CASE REPORT: We presented a case of 50-year-old man suffering from a slow-growing, painless giant chondrosarcoma of the anterior chest wall. A wide resection was performed to excise the tumor including attached skin, right breast, ribs, sternum, soft tissues and parietal pleura. Mediastinum was not affected by the tumor. After resecting a 26 x 20 x 22 cm segment, the chest wall defect was reconstructed with a Marlex mesh and extensive latissimus dorsi myocutaneous flap pedicled on the right thoracodorsal vessels. Histopathology diagnosis was chondrosarcoma G 2-3. The mechanics of ventilation was not altered and respiratory function was normal from the immediate postoperative period. Three years after the operation postoperative results showed no local recurrence and excellent functional and aesthetic results were evident. Respiratory function remained unaltered. CONCLUSION: According to the results it can be concluded that the use of Marlex mash and myocutaneous flap is good method for stabilization of the chest wall and enough to avoid paradoxical respiratory movements in managing giant chondrosarcoma of the anterior chest wall.     

生物材料人工胸壁结构设计及其评价

目的 通过生物材料的筛选和优化组合及特殊工艺制备新型人工胸壁结构,并探讨其应用于大块胸壁缺损重建的可行性.方法 根据胸壁重建需要,筛选出适宜的可降解高分子生物材料,通过特殊工艺制成三种不同结构的人工胸壁(聚对二氧杂环己酮纤维网、甲壳素纤维增强聚已内酯板、甲壳素纤维增强聚已内酯肋条).建立犬大块胸壁缺损动物模型,应用所研制的人工材料进行动物实验,通过动态观察及组织学检查评价其效果.结果 聚对二氧杂环已酮网重建胸壁与组织结合良好,可有效减轻反常呼吸,网状材料24周内完全降解吸收,被自体再生组织取代,胸壁长期稳定性和胸廓外形满意.甲壳素纤维增强聚已内酯板重建胸壁可获得良好的胸壁固定,肋条可有效防止反常呼吸,同时具有更佳的组织相容性.甲壳素纤维增强聚已内酯材料植入24周无明显变化.结论 聚对二氧杂环已酮网及甲壳素纤维增强聚已内酯材料具有良好的组织相容性,可有效防止反常呼吸,在胸壁重建中各具特点,具有一定的临床应用价值.     

Tuberculous osteomyelitis/arthritis of the first costo-clavicular joint and sternum

A young Somali immigrant presents with a two-year history of a large, firm, painful right anterolateral chest wall sternal mass. The patient denied any history of trauma or infection at the site and did not have a fever, erythematous lesion at the site, clubbing, or lymphadenopathy. A lateral chest radiograph demonstrated a low density mass isolated to the subcutaneous soft tissue overlying the sternum, ribs and clavicle. Computed tomography (CT) with contrast demonstrated a cystic lesion in the right anterolateral chest wall deep to the pectoralis muscle. Enhanced CT of the chest demonstrated sclerosis and destruction of the rib and costochondral joint and manubrio-sternal joint narrowing. Ultrasound-guided biopsy and aspiration returned 500 cc of purulent, cloudy yellow, foul-smelling fluid. Acid-fact bacilli stain and the nucleic acid amplification test identified and confirmed Mycobacterium tuberculosis. A diagnosis of tuberculous osteomyelitis/septic arthritis was made and antibiotic coverage for tuberculosis was initiated.     

Non-Tumorous Diseases of the Sternum and Its Articulations: At the Front Gate of the Chest

Abnormalities of the sternal and peri-sternal regions are commonly seen in clinical practice and may be one of the important causes of chest pain particularly anterior chest wall pain. While reading computed tomography (CT) of the chest for evaluation of chest pain, the sternal region is either easily overlooked or its abnormality is often detected incidentally. This article will provide an overview of normal sternal anatomy and congenital variants as well as a variety of non-tumorous pathologic conditions of the sternum and adjacent joints, with emphasis on CT, to help radiologists, particularly thoracic radiologists, to make an accurate diagnosis in their daily practice. Non-tumorous abnormalities include trauma (fractures and dislocations), infection (osteomyelitis, septic arthritis), degenerative (osteoarthritis) and inflammatory conditions (rheumatoid arthritis, seronegative arthritides), and metabolic disorders (Paget's disease and renal osteodystrophy) as well as treatment related changes such as poststernotomy and its complications (dehiscence, nonunion) and postradiation changes of the sternum.     

Atraumatic sternal fractures secondary to osteoporosis

We describe two cases of spontaneous sternal fracture with no underlying pathology other than a severe dorsal kyphosis resulting from osteoporosis. Both patients complained of chest pain. Sternal fractures are particularly likely to occur in the elderly when the costal cartilages become ossified and there is an associated thoracic kyphosis. In elderly patients with a kyphosis the lateral thoracic radiograph should include the sternum to ensure recognition of this complication.