Dharmaraj Benedict, Diong Nguk Chai, Shamugam Navindra, Sathiamurthy Narasimman, Mohd Zainal Hamidah, Chai Siew Cheng, Koh Khai Luen, Mat Zain Mohammad Ali, Haji Basiron Normala
Thoracic Surgery Unit, Department of General Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
Indian J Thorac Cardiovasc Surg. 2021 Jan;37(1):82-88. doi: 10.1007/s12055-020-00972-7. Epub 2020 Aug 7.
Chest wall resection is defined as partial or full-thickness removal of the chest wall. Significant morbidity has been recorded, with documented respiratory failure as high as 27%. Medical records of all patients who had undergone chest wall resection and reconstruction were reviewed. Patients' demographics, length of surgery, reconstruction method, size of tumor and chest wall defect, histopathological result, complications, duration of post-operative antibiotics, and hospital stay were assessed. From 1 April 2017 to 30 April 2019, a total of 20 patients underwent chest wall reconstructive surgery. The median age was 57 years, with 12 females and 8 males. Fourteen patients (70%) had malignant disease and 6 patients (30%) had benign disease. Nine patients underwent rigid reconstruction (titanium mesh for sternum and titanium plates for ribs), 6 patients had non-rigid reconstruction (with polypropylene or composite mesh), and 5 patients had primary closure. Nine patients (45%) required closure with myocutaneous flap. Complications were noted in 70% of patients. Patients who underwent primary closure had minor complications. In total, 66.7% of patients who had closure with either fasciocutaneous or myocutaneous flaps had threatened flap necrosis. Two patients developed pneumonia and 3 patients (15%) had respiratory failure requiring tracheostomy and prolonged ventilation. There was 1 mortality (5%) in this series. In conclusion, chest wall resections involving large defects require prudent clinical judgment and multidisciplinary assessments in determining the choice of chest wall reconstruction to improve outcomes.
胸壁切除术定义为胸壁的部分或全层切除。已记录到显著的发病率，有记录显示呼吸衰竭高达27%。对所有接受胸壁切除和重建的患者的病历进行了回顾。评估了患者的人口统计学特征、手术时长、重建方法、肿瘤和胸壁缺损大小、组织病理学结果、并发症、术后抗生素使用时长以及住院时间。2017年4月1日至2019年4月30日，共有20例患者接受了胸壁重建手术。中位年龄为57岁，其中女性12例，男性8例。14例患者（70%）患有恶性疾病，6例患者（30%）患有良性疾病。9例患者接受了刚性重建（胸骨用钛网，肋骨用钛板），6例患者进行了非刚性重建（使用聚丙烯或复合网），5例患者进行了一期缝合。9例患者（45%）需要用肌皮瓣进行闭合。70%的患者出现了并发症。接受一期缝合的患者出现的并发症较轻。总体而言，66.7%接受筋膜皮瓣或肌皮瓣闭合的患者出现了皮瓣坏死风险。2例患者发生肺炎，3例患者（15%）出现呼吸衰竭，需要气管切开和长时间通气。本系列中有1例死亡（5%）。总之，涉及大缺损的胸壁切除术在确定胸壁重建的选择时需要谨慎的临床判断和多学科评估，以改善治疗效果。
