Danino A, Saito S, Mamlouk K, Cuminet J, Debrosse D, Gossot D, Le Pinsec-Barthes F, Revol M, Riquet M, Servant J M
Service de chirurgie plastique (Pr J.M. Servant), hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010, Paris, France.
Ann Chir Plast Esthet. 2003 Apr;48(2):86-92. doi: 10.1016/s0294-1260(03)00011-6.
To assess the results of surgical resection and chest wall reconstruction we reviewed our experience with the complete chest wall reconstruction after en bloc excisions according to an original algorithm based on the location of the thoracic defect. The 14 reconstructions were performed by the senior author. We found 5 central, 6 lateral and 3 borders locations. In the central locations with a total resection of the sternum the reconstruction was realized by Gore-tex's mesh in depth, metal hooks (staples) and Marlex's mesh under a musculocutaneous flap of coverage. In case of lateral location the reconstruction was realized by Gore-tex's mesh covered with a musculocutaneous flap, the borders locations were reconstructed by Marlex's mesh and flap of coverage. The histological diagnoses were: one desmoid tumor, eight sarcomas, a recurrence of hepatocarcinoma and four recurrences of breast cancer. The superficial coverage performed by latissimus dorsis flap 12 for cases and rectus abdominis flap for two cases. All the patients were able to produce a spontaneous breath after surgery. Two deaths at distance and an infection were to regret. On the whole the algorithm of reconstruction according to the location of the defect allows a simplification of the indications.
为评估手术切除及胸壁重建的结果，我们回顾了根据基于胸壁缺损位置的原始算法进行整块切除术后完整胸壁重建的经验。14例重建手术均由资深作者完成。我们发现有5例位于中央、6例位于外侧、3例位于边缘。在全胸骨切除的中央位置，采用Gore-tex网片置于深部、金属钩（钉）以及在肌皮瓣覆盖下的Marlex网片进行重建。对于外侧位置，采用覆盖肌皮瓣的Gore-tex网片进行重建，边缘位置则用Marlex网片及覆盖皮瓣进行重建。组织学诊断为：1例硬纤维瘤、8例肉瘤、1例肝癌复发以及4例乳腺癌复发。12例采用背阔肌皮瓣进行表面覆盖，2例采用腹直肌皮瓣。所有患者术后均能自主呼吸。有2例远期死亡及1例感染令人遗憾。总体而言，根据缺损位置的重建算法可简化适应证。
