Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland.
Scand J Surg. 2013;102(1):9-13. doi: 10.1177/145749691310200103.
Most chest wall defects requiring reconstruction result from tumor resection. Bone and soft tissue sarcomas and recurrent mammary cancer are the most common tumors. Careful preoperative evaluation, meticulous surgical technique and active postoperative treatment are important. The selection of reconstruction is based on the nature, size and location of the defect as well as on the general health and prognosis of the patient. The goals of the reconstruction are adequate stability, water- and airtight closure of the chest cavity, and acceptable cosmetic appearance. The pedicled muscular or musculocutaneous flaps are usually the first choice for tis-sue coverage. These include flaps such as latissimus dorsi, vertical or transverse rectus abdominis and pectoralis. In certain cases also the breast flap or omental flap can be used. In selected cases, a free flap reconstruction is indicated if the local options for reconstruction have been used, or if they are unreliable due to earlier scars or radiotherapy. The free flaps to be used for chest wall can be harvested from the thigh (tensor fascia latae flap, anterolateral thigh flap), from the abdomen (transverse rectus abdominis flaps, deep epigastric perforator flaps) or from the chest wall (latissimus dorsi flap and other flaps based on the subscapular artery). Sometimes a fillet forearm can be used as a flap to cover a defect after extended forequarter amputation. Artificial meshes are commonly used to give stability in the defect and to give a platform for the flap. Methylmethacrylate embedded between the two layers of a mesh, or one or two rib grafts fixed to the mesh, can be used to give additional stability in extensive defects to prevent paradoxical movement.
大多数需要重建的胸壁缺陷是由肿瘤切除引起的。骨和软组织肉瘤以及复发性乳腺癌是最常见的肿瘤。仔细的术前评估、精细的手术技术和积极的术后治疗非常重要。重建的选择基于缺陷的性质、大小和位置，以及患者的整体健康状况和预后。重建的目标是充分的稳定性、胸腔的水密和气密闭合以及可接受的美容外观。带蒂的肌肉或肌皮瓣通常是组织覆盖的首选。这些包括背阔肌、垂直或横形腹直肌和胸大肌等皮瓣。在某些情况下，也可以使用乳房皮瓣或网膜皮瓣。在某些情况下，如果已经使用了局部重建选项，或者由于早期疤痕或放射治疗导致它们不可靠，则需要进行游离皮瓣重建。用于胸壁的游离皮瓣可以从大腿（阔筋膜张肌皮瓣、前外侧大腿皮瓣）、腹部（横形腹直肌皮瓣、腹壁下动脉穿支皮瓣）或胸壁（背阔肌皮瓣和其他基于肩胛下动脉的皮瓣）中采集。有时，延伸的前 quarter 截肢后，可以使用前臂皮瓣来覆盖缺损。人工网片常用于为缺陷提供稳定性，并为皮瓣提供平台。可以使用将甲基丙烯酸甲酯嵌入网片的两层之间，或用一个或两个肋骨移植物固定在网片上，以在广泛的缺陷中提供额外的稳定性，防止反常运动。
