Bobin J Y, Mignotte H, Crozet B, Lupo C, Zlatoff P
Service de chirurgie, Centre Léon-Bérard, Lyon, France.
Bull Cancer. 1990;77(9):901-10.
Based on our experience with 12 patients who underwent wide anterior chest wall resection in our institute, we attempt to define the indication of the different techniques for reconstruction by musculo-cutaneous flaps according to the extent of resection and location in the chest wall. The pectoralis major flaps are simple and important in the reconstruction of sternal defects; especially when dense retrosternal fibrosis has already developed after radiotherapy. The latissimus dorsi flaps are reliable and thick and suitable for coverage of major tissue loss. A new technique is also described for reconstruction of major anterolateral chest wall defects as well as sternal defects by a latissimus dorsi osteo-muscular flap. The external oblique musculo-cutaneous flaps are used to cover defects in the lateral chest wall below the 5th rib. Pedicled omental flaps are complementary flaps and can be used when muscle flaps are insufficient to replace significant tissue loss. Respiratory problems arising from paradoxical chest wall movement are temporary and may be encountered in the immediate post-operative period. Because of the development of fibrosis and of a better adaptation of the patient, this condition is well tolerated during the month following operation.
基于我们对在我院接受前胸壁广泛切除的12例患者的经验，我们试图根据胸壁切除范围和部位来确定采用肌皮瓣重建的不同技术的适应证。胸大肌瓣在胸骨缺损的重建中简单且重要；特别是在放疗后已出现致密的胸骨后纤维化时。背阔肌瓣可靠且厚实，适合覆盖大面积组织缺损。还描述了一种利用背阔肌骨肌瓣重建前胸壁外侧及胸骨主要缺损的新技术。腹外斜肌肌皮瓣用于覆盖第5肋以下的胸壁外侧缺损。带蒂大网膜瓣是补充性瓣，当肌瓣不足以替代大量组织缺损时可使用。反常胸壁运动引起的呼吸问题是暂时的，可能在术后即刻出现。由于纤维化的发展以及患者更好的适应性，这种情况在术后1个月内可被良好耐受。
