CHEST-WALL RECONSTRUCTION FOLLOWING RESECTION OF LARGE PRIMARY MALIGNANT-TUMORS

被引：73

作者：

CHAPELIER, A

MACCHIARINI, P

RIETJENS, M

LENOT, B

MARGULIS, A

PETIT, JY

DARTEVELLE, P

机构：

[1] Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue (Paris-Sud University), Le Plessis Robinson, F-92350

[2] Department of Plastic and Reconstructive Surgery, Institut Gustave Roussy, Villejuif Parisd University

来源：

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY | 1994年 / 8卷 / 07期

关键词：

CHEST WALL; PRIMARY TUMORS; RESECTION; RECONSTRUCTION; MUSCLE FLAPS;

D O I：

10.1016/1010-7940(94)90028-0

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Reconstructive procedures following radical resection of large primary malignant chest wall tumors (PMCWT) continue to evolve. Between 1982 and 1993, 32 consecutive patients (18 males/14 females) with a median age of 47 years (range, 12 - 77) underwent radical resection for large (median 10 +/- 5.4 cm) PMCWTs arising either from the bone (n = 15) or soft tissues (n = 17) of the chest wall. Nine (28%) had previous surgical resection before referral. Sixteen (50%) required extensive skin excision. Twelve sternectomies (5 total and 7 partial) and 20 lateral chest wall resections were performed. In this latter group, 16 patients (80%) had at least three ribs resected. Resection extended to the lung (10 wedge resections, 2 lobectomies and 1 pneumonectomy) in 13 patients, diaphragm in 3, abdominal wall in 2, brachiocephalic and subclavian vessels in 5, superior vena cava in 1 and upper limb in 1. Stability of the chest wall was obtained with prosthetic material in 27 patients, including Marlex (n = 21), polytetrafluoroethylene (PTFE) (n = 4) and polyglactin (n = 2) meshes. After sternectomy, six patients had a methyl methacrylate mesh reinforcement while soft tissue reconstruction was carried out using the pectoralis major muscle (PM), either alone with skin advancement (n = 8) or as a myocutaneous flap in three males (unilateral n = 2, bilateral n = 1) and by a latissimus dorsi (LD) myocutaneous flap in one female. Muscle transposition was used to reconstruct defects of the lateral chest wall and included 10 LD, 6 PM and 2 serratus anterior (SA) muscles, with associated advancement of the diaphragm in two cases. Two patients required rectus abdominis myocutaneous flaps because other local muscles had been previously excised and irradiated. One (3%) hospital death occurred as a result of bacterial pneumonia. Two septic local complications after total sternectomy required removal of the prosthetic material but both myocutaneous naps were preserved. With a median follow-up of 38 months, overall 2- and 5-year survival rates were 66% and 50%, respectively. Local recurrence developed in four cases (12.5%). Chest wall stabilization is essential after resection of large anterior and lateral PMCWTs; soft tissue coverage is possible using well vascularized muscle or myocutaneous flaps.

引用

页码：351 / 357

页数：7

共 23 条

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