Wong Teddy H Y, Siu Ivan C H, Lo Kareem K N, Tsang Ethan Y H, Wan Innes Y P, Lau Rainbow W H, Chiu T W, Ng Calvin S H
Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
Division of Plastic and Reconstructive Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
Front Surg. 2022 Jul 5;9:947193. doi: 10.3389/fsurg.2022.947193. eCollection 2022.
Chest wall tumor resection can result in a large defect that can pose a challenge in reconstruction in restoring chest wall contour, maintaining respiratory mechanics, and improving cosmesis. Titanium plates were first introduced for treating a traumatic flail chest, which yielded promising results in restoring chest wall stability. Subsequently, the applications of titanium plates in chest wall reconstruction surgery were demonstrated in case reports and series. Our center has adopted this technique for a decade, and patients are actively followed up after operation. Here, we retrospectively analyze our 10-year experience of using titanium plates and other reconstruction approaches for chest wall reconstruction, in terms of clinical outcomes, complications, and reasons for reoperation to determine long-term safety and efficacy. Thirty-eight patients who underwent chest wall resection and reconstruction surgery were identified. Of these, 11 had titanium plate insertion, 11 had patch repair or flap reconstruction, and the remaining 16 had primary closure of defects. Chest wall reconstruction using titanium plate(s) and patch repair (with or without flap reconstruction) was associated with larger chest wall defects and more sternal resections than primary closure. Subgroup analysis also showed that reconstruction by the titanium plate technique was associated with larger chest wall defects than patch repair or flap reconstruction [286.80 cm vs. 140.91 cm ( = 0.083)]. There was no 30-day hospital mortality. Post-operative arrhythmia was more commonly seen following chest wall reconstruction compared with primary closure ( = 0.041). Furthermore, more wound infections were detected following the use of titanium plate reconstruction compared with the patch repair (with or without flap reconstruction) approach ( = 0.027). In conclusion, the titanium plate system is a safe, effective, and robust approach for chest wall reconstruction surgery, especially in tackling larger defect sizes.
胸壁肿瘤切除可导致较大缺损，这在重建胸壁轮廓、维持呼吸力学和改善美观方面的重建过程中可能构成挑战。钛板最初被用于治疗创伤性连枷胸，在恢复胸壁稳定性方面取得了令人满意的结果。随后，钛板在胸壁重建手术中的应用在病例报告和系列研究中得到了证实。我们中心采用这项技术已有十年，术后对患者进行积极随访。在此，我们回顾性分析我们使用钛板及其他重建方法进行胸壁重建的10年经验，包括临床结果、并发症以及再次手术的原因，以确定其长期安全性和有效性。确定了38例行胸壁切除重建手术的患者。其中，11例行钛板植入，11例行补片修补或皮瓣重建，其余16例行缺损一期闭合。与一期闭合相比，使用钛板和补片修补（有或无皮瓣重建）进行胸壁重建与更大的胸壁缺损和更多的胸骨切除相关。亚组分析还显示，钛板技术重建的胸壁缺损比补片修补或皮瓣重建更大[286.80 cm对140.91 cm（=0.083）]。无30天住院死亡率。与一期闭合相比，胸壁重建术后更常见心律失常（=0.041）。此外，与补片修补（有或无皮瓣重建）方法相比，使用钛板重建后检测到更多伤口感染（=0.027）。总之，钛板系统是胸壁重建手术的一种安全、有效且可靠的方法，尤其适用于处理较大的缺损尺寸。
