Immediate reconstruction of full-thickness chest wall defects.
Immediate reconstruction of full-thickness chest wall defects.
复制标题
立即重建全层胸壁缺损。
DOI：
10.1016/s0003-4975(10)61754-7
复制
发表时间：
1981
影响因子：
4.6
通讯作者：
Frank C. Spencer
中科院分区：
文献类型：
--
作者：
A. D. Boyd;William W. Shaw;Joseph G. McCarthy;Daniel C. Baker;Naresh Trehan;Anthony J. Acinapura;Frank C. Spencer
过去十年来，纽约大学医学中心有 21 名患者进行了全层胸壁缺损重建。 Marlex 网片为 5 名患者提供了胸壁稳定性。 9 名患有放射性溃疡的患者不需要使用 Marlex 网片；严重的纤维化反应已经消除了胸膜腔并阻止了反常运动。部分胸骨切除术不需要 Marlex 稳定，而全胸骨切除术会导致患者出现明显的通气不足，而使用稳定材料本来可以受益。最初使用随机图案皮瓣；最近，采用了轴型皮瓣、肌皮瓣和游离肌皮瓣。 11 名随机皮瓣患者中，有 4 名（36%）出现坏死，但采用较新的皮瓣技术并未出现坏死。肌皮游离皮瓣为三个可能污染的大缺陷提供了简单的覆盖和稳定性。看来，利用目前可用的皮瓣技术和胸壁稳定方法，立即修复所有全层胸壁缺损是可能的。
Twenty-one patients had full-thickness chest wall defects reconstructed at the New York University Medical Center in the last ten years. Marlex mesh provided chest wall stability in 5 patients. In 9 patients with radiation ulcers Marlex mesh was not required; a severe fibrotic reaction had obliterated the pleural space and prevented paradoxical motion. Partial sternal resections did not require Marlex stabilization, while a total sternectomy resulted in marked ventilatory insufficiency in a patient who would have benefited from the use of a stabilizing material. Random pattern flaps were used initially; more recently, axial pattern, myocutaneous, and myocutaneous free flaps were employed. Necrosis developed in 4 (36%) of the 11 patients with random pattern flaps, but was not seen with the newer flap techniques. Myocutaneous free flaps provided uncomplicated coverage of and stability to three large, potentially contaminated defects. It seems that with the currently available flap techniques and the methods of chest wall stabilization, immediate repair of all full-thickness chest wall defects is possible.