Plastic and Reconstructive Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
J Plast Reconstr Aesthet Surg. 2010 May;63(5):e458-62. doi: 10.1016/j.bjps.2009.07.003. Epub 2009 Aug 21.
Extensive posterior chest wall defects, especially those closer to the midline of the trunk, pose surgical challenges in plastic surgery. In these cases, prior to tissue coverage, the status of the pleural cavity and skeletal support need to be addressed to obtain a functional and anatomical reconstruction. We recently operated upon a patient presenting with an aggressive ossifying fibromyxoid tumour located in the lower dorsal paraspinal region on the right side. After ablative surgery and intra-operative radiotherapy, a broad defect in the chest wall of 15 x 10 cm, including the proximal part of five posterior ribs, was presented. It required immediate bony frame reconstruction, which was resolved with a Goretex patch wrapped with a de-epithelised myocutaneous pedicled transverse rectus abdominus myocutaneous (TRAM) flap, transposed through the right hemithorax. The patient was extubated 2 days after surgery and discharged in 10 days. We describe the use of an intra-thoracic TRAM flap to reach the posterior chest wall defects, and we propose its specific indication for reconstruction of extensive posterior chest wall defects when other options are unavailable.
广泛的胸壁后部缺损，特别是更靠近躯干中线的缺损，给整形外科带来了手术挑战。在这些情况下，在进行组织覆盖之前，需要解决胸腔和骨骼支撑的状况，以实现功能和解剖重建。我们最近为一名患者进行了手术，该患者右侧下背部脊柱旁区域存在侵袭性成骨性纤维黏液样肿瘤。在进行消融手术后，术中进行了放射治疗，患者出现了 15x10cm 的广泛胸壁缺损，包括五个后肋骨的近端部分。这需要立即进行骨框架重建，我们使用 Goretex 补片包裹去上皮化的带蒂腹直肌肌皮瓣（TRAM）瓣通过右侧胸腔进行转移，解决了这个问题。患者在手术后 2 天拔管，10 天后出院。我们描述了使用胸腔内 TRAM 瓣来覆盖胸壁后部缺损，并提出了在其他方法不可用时，该方法是重建广泛胸壁后部缺损的特定适应证。
