Ong Kingsfield, Ong Chin Siang, Chua Yang Chong, Fazuludeen Ali Akbar, Ahmed Aneez Dokeu Basheer
Division of Thoracic Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore.
Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
J Thorac Dis. 2018 May;10(5):2890-2897. doi: 10.21037/jtd.2018.04.116.
A plethora of new biomaterials and dedicated rib fixator implant systems have been introduced into the field of chest wall reconstruction. The aim of our study is to evaluate the surgical outcomes of a novel combination of the anatomically contoured titanium rib implant and porcine dermal collagen patch for chest wall reconstruction.
We performed a retrospective review of eight consecutive patients who underwent chest wall resection and reconstruction between January 2014 to August 2015 in a single institution. MatrixRib Fixation System and Permacol Surgical Implant were utilized to achieve chest wall reconstruction.
The indication for reconstruction was malignant infiltration in 50% of patients. Three other subjects (37.5%) had chest wall resections to achieve adequate and safe surgical exposure. One patient had a right lung apical mycetoma with chest wall invasion. All patients underwent lung resections with the removal of 2 to 6 (median 3) ribs. Reconstruction was performed using the MatrixRib system, with a median of 2.5 (range, 2-4) ribs fixed in each patient. There was no post-operative mortality. One patient had a superficial wound infection which resolved with one week of oral antibiotics. Upon discharge, the pain scores were near zero with minimal analgesic requirements. None of the patients required repeat surgery or removal of their implants.
Our early experience indicates that the combination of the MatrixRib system and Permacol patch for chest wall reconstruction is safe and feasible with promising results in terms of anatomical restoration of the chest wall mechanics, infection and pain.
大量新型生物材料和专用肋骨固定植入系统已被引入胸壁重建领域。我们研究的目的是评估解剖轮廓钛肋骨植入物与猪真皮胶原蛋白贴片联合用于胸壁重建的手术效果。
我们对2014年1月至2015年8月在单一机构接受胸壁切除和重建的连续8例患者进行了回顾性研究。使用MatrixRib固定系统和Permacol外科植入物进行胸壁重建。
50%的患者重建指征为恶性浸润。其他3名患者(37.5%)进行胸壁切除以获得充分和安全的手术暴露。1例患者患有右肺尖部霉菌瘤并侵犯胸壁。所有患者均接受了肺切除术,切除2至6根(中位数3根)肋骨。使用MatrixRib系统进行重建,每位患者固定的肋骨中位数为2.5根(范围2 - 4根)。无术后死亡病例。1例患者发生浅表伤口感染,口服抗生素1周后痊愈。出院时,疼痛评分接近零,镇痛需求极少。所有患者均无需再次手术或取出植入物。
我们的早期经验表明,MatrixRib系统和Permacol贴片联合用于胸壁重建是安全可行的,在胸壁力学的解剖恢复、感染和疼痛方面取得了有前景的结果。