Department of Orthopedic Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas.
Semin Plast Surg. 2011 Feb;25(1):86-97. doi: 10.1055/s-0031-1275175.
Chest wall and mediastinal wounds may be life-threatening. Although modern reconstruction methods with various muscle flaps have reduced morbidity and mortality, chest wall reconstruction presents unique challenges. Major categories of adverse outcomes include (1) persistent infection; (2) interference with respiratory mechanics; (3) functional deficits of the shoulder; and (4) hernias. Persistent infection may be resolved by providing coverage via muscle or omental flap, performing thorough debridement, filling the "dead space" with adequate volume, buttressing repair of visceral fistulae, and covering exposed prosthetic material with vascularized flaps. Potential deficits in respiratory mechanics and shoulder function may be avoided by stabilizing the chest wall skeleton and decreasing donor muscle functional loss. Hernias may be minimized by maintaining visceral "right of domain" to the chest and abdominal cavities. Complex reconstructive cases represent an intricate interplay of physiology, structural protection, and aesthetic considerations and require integration of several management principles.
胸壁和纵隔创伤可能危及生命。尽管各种带肌瓣的现代重建方法降低了发病率和死亡率，但胸壁重建仍存在独特的挑战。主要的不良后果包括：（1）持续感染；（2）呼吸力学干扰；（3）肩部功能缺陷；（4）疝。通过肌瓣或大网膜瓣覆盖、彻底清创、用足够的体积填充“死腔”、支撑内脏瘘管修复以及用带血管化皮瓣覆盖暴露的假体材料，可以解决持续性感染问题。通过稳定胸壁骨架和减少供体肌肉功能丧失，可以避免呼吸力学和肩部功能的潜在缺陷。通过保持内脏对胸腔和腹腔的“权利”，可以最大限度地减少疝的发生。复杂的重建病例涉及生理、结构保护和美学考虑等多个因素的复杂相互作用，需要整合多个管理原则。
