Graeber G M
Department of Surgery, West Virginia University School of Medicine, Morgantown 26506, USA.
Semin Thorac Cardiovasc Surg. 1999 Jul;11(3):251-63. doi: 10.1016/s1043-0679(99)70066-3.
Chest wall reconstruction has been refined and expanded in recent years so that almost any defect may be repaired with an excellent cosmetic and physiological result. The first step in a good reconstruction is an appropriate and thorough resection that leaves healthy, viable margins to which the materials and tissues used in a reconstruction may be anchored securely. In most instances, chest wall stabilization will not be necessary. In some cases in which large areas of chest wall will be removed or a lateral aspect of a chest wall needs to be resected, stabilization may be necessary. Stabilization may also be required in patients who suffer from debilitating lung disease and need a chest wall resection and reconstruction. Soft tissue coverage completes the reconstruction by moving healthy, viable tissue to fill the defect. In most instances, pedicled muscular, musculocutaneous, and omental flaps will provide adequate soft tissue coverage. Very infrequently, a free flap will be necessary to achieve total closure of a chest wall defect. The soft tissue coverage is completed by using meshed, split thickness skin grafts to provide epithelialization of any exposed muscle or omentum.
近年来，胸壁重建技术不断完善和拓展，几乎任何缺损都能得到修复，且美容效果和生理功能恢复良好。成功重建的第一步是进行恰当且彻底的切除，确保留下健康、有活力的边缘，以便牢固地固定重建所用的材料和组织。在大多数情况下，胸壁稳定并非必要。在某些需要切除大面积胸壁或切除胸壁外侧部分的病例中，可能需要进行稳定处理。患有严重肺部疾病且需要进行胸壁切除和重建的患者也可能需要稳定处理。软组织覆盖通过转移健康、有活力的组织填充缺损来完成重建。在大多数情况下，带蒂肌瓣、肌皮瓣和网膜瓣将提供足够的软组织覆盖。极少数情况下，需要游离皮瓣才能完全闭合胸壁缺损。通过使用网状、中厚皮片移植使任何暴露的肌肉或网膜上皮化，从而完成软组织覆盖。
