Sanna Stefano, Brandolini Jury, Pardolesi Alessandro, Argnani Desideria, Mengozzi Marta, Dell'Amore Andrea, Solli Piergiorgio
Thoracic Surgery Unit, G. B. Morgagni Hospital, Forli, Italy.
Thoracic Surgery Unit, S. Orsola Hospital, Bologna, Italy.
J Vis Surg. 2017 Jul 26;3:95. doi: 10.21037/jovs.2017.06.10. eCollection 2017.
Extensive chest wall resection and reconstruction are a challenging procedure that requires a multidisciplinary approach, including input from thoracic surgeon, plastic surgeon and oncologist. In particular chest wall neoplastic pathology is associated with high surgical morbidity and can result in full thickness defects hard to reconstruct. The goals of a successful chest wall reconstruction are to restore the chest wall rigidity, preserve pulmonary mechanic and protect the intrathoracic organs minimizing the thoracic deformity. In case of large full thickness defects synthetic, biologic or composite meshes can be used, with or without titanium plate to restore thoracic cage rigidity as like as more recently the use of allograft to reconstruct the sternum. After skeletal stability is established full tissue coverage can be achieved using direct suture, skin graft or local advancement flaps, pedicled myocutaneous flaps or free flaps. The aim of this article is to illustrate the indications, various materials and techniques for chest wall reconstruction with the goal to obtain the best chest wall rigidity and soft tissue coverage.
广泛胸壁切除与重建是一项具有挑战性的手术，需要多学科方法，包括胸外科医生、整形外科医生和肿瘤学家的参与。特别是胸壁肿瘤病理学与高手术发病率相关，可导致难以重建的全层缺损。成功的胸壁重建目标是恢复胸壁刚性，保持肺力学功能，保护胸内器官，使胸廓畸形最小化。对于大的全层缺损，可使用合成材料、生物材料或复合网片，可带或不带钛板以恢复胸廓刚性，就像最近使用同种异体移植物重建胸骨一样。在建立骨骼稳定性后，可通过直接缝合、植皮、局部推进皮瓣、带蒂肌皮瓣或游离皮瓣实现全组织覆盖。本文旨在阐述胸壁重建的适应证、各种材料和技术，目标是获得最佳的胸壁刚性和软组织覆盖。
