Gao Kun, Huang Fuguo, Liu Lunxu
Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2007 Dec;21(12):1319-22.
To observe an early result after the repair of the large upper thoracic wall defect by a combined use of the titanium net, reconstruction nickelclad, and latissimus dorsi myocutaneous flap in a patient who underwent a breast sarcomatoid caricinoma resection on the upper thoracic wall.
A breast sarcomatoid carcinoma in the upper thoracic wall was removed in 1 56-year-old female patient in February 2006. After the tumorectomy, a large thoracic wall defect was left, which was 20 cm X 15 cm in size. The defect was covered by the titanium net, the bilateral stumps of the clavicles were connected by the reconstruction nickelclad, and the soft tissue defect was repaired with the right latissimus dorsi myocutaneous flap (20 cm x 15 cm).
The patient depended on the breathing machine for 3 days after operation. When the breathing machine was discontinued, the patient developed a severe paradoxical breathing. Two weeks after operation when the blood circulation of the flap was stabilized, the paradoxical breathing disappeared with the help of the chest bandage for fixation of the chest cavity, and the blood supply of the flap was improved. The chest X-ray film showed that the titanium net and the reconstruction nickelclad were well positioned. The patient received chemotherapy 1 month after operation, The follow-up for 3 months revealed that the patient's local condition and physical condition were good, and ROM of both the shoulders was improved, with AF 90 degrees and ABD 90 degrees. No recurrence of the tumor was found.
A large thoracic wall defect should be repaired with solid materials. The normal anatomic locations of the clavicles should be maintained with fixation by the reconstruction nickelclad for a good function of the shoulders. The latissimus dorsi myocutaneous flap can be properly enlarged.
观察1例胸壁上部乳腺肉瘤样癌切除术后患者，联合应用钛网、重建镍包钢及背阔肌肌皮瓣修复胸壁上部大缺损后的早期效果。
2006年2月，1例56岁女性患者行胸壁上部乳腺肉瘤样癌切除术。肿瘤切除后，遗留一个大小为20 cm×15 cm的胸壁大缺损。缺损处用钛网覆盖，双侧锁骨残端用重建镍包钢连接，软组织缺损用右侧背阔肌肌皮瓣（20 cm×15 cm）修复。
患者术后依赖呼吸机3天。撤机后出现严重反常呼吸。术后2周，皮瓣血液循环稳定，在胸腔固定胸带的帮助下反常呼吸消失，皮瓣血供改善。胸部X线片显示钛网和重建镍包钢位置良好。患者术后1个月接受化疗，随访3个月显示患者局部情况和身体状况良好，双肩活动度改善，前屈90度，外展90度。未发现肿瘤复发。
胸壁大缺损应用坚固材料修复。用重建镍包钢固定以维持锁骨正常解剖位置，有利于肩部功能恢复。背阔肌肌皮瓣可适当扩大。
