Pairolero P C, Arnold P G
Mayo Clin Proc. 1986 Jul;61(7):557-63. doi: 10.1016/s0025-6196(12)62004-7.
In this article, we review our experience during the past 9 years with 205 consecutive thoracic wall reconstructions. The 100 female and 105 male patients ranged in age from 12 to 85 years (mean, 53.4 years). One hundred fourteen patients had thoracic wall tumors, 56 had radiation necrosis, 56 had infected median sternotomy wounds, and 8 had costochondritis. Twenty-nine of these patients had combinations of the aforementioned conditions. One hundred seventy-eight patients underwent skeletal resection. A mean of 5.4 ribs were resected in 142 patients. Total or partial sternectomies were performed in 60. Skeletal defects were closed with prosthetic material in 66 patients and with autogenous ribs in 12. One hundred sixty-eight patients underwent 244 muscle flap procedures: 149 pectoralis major, 56 latissimus dorsi, 14 rectus abdominis, 13 serratus anterior, 8 external oblique, 2 trapezius, and 2 advancement of diaphragm. The omentum was transposed in 20 patients. The mean number of operations per patient was 1.9 (range, 1 to 8). The mean duration of hospitalization was 16.5 days. One perioperative death occurred (at 29 days). Four patients required tracheostomy. During a mean follow-up of 32.4 months, there were 49 late deaths, predominantly due to malignant disease. All 204 patients who were alive 30 days after operation had excellent surgical results at last follow-up examination or at the time of death due to causes unrelated to the reconstructive procedure.
在本文中，我们回顾了过去9年中连续进行的205例胸壁重建手术的经验。100例女性和105例男性患者年龄在12至85岁之间（平均53.4岁）。114例患者患有胸壁肿瘤，56例有放射性坏死，56例有正中胸骨切开术后感染伤口，8例有肋软骨炎。其中29例患者合并有上述多种情况。178例患者接受了骨骼切除。142例患者平均切除5.4根肋骨。60例患者进行了全胸骨或部分胸骨切除。66例患者用假体材料闭合骨骼缺损，12例用自体肋骨闭合。168例患者接受了244次肌瓣手术：149例胸大肌、56例背阔肌、14例腹直肌、13例前锯肌、8例腹外斜肌、2例斜方肌和2例膈肌推进术。20例患者进行了大网膜转移。每位患者的平均手术次数为1.9次（范围为1至8次）。平均住院时间为16.5天。发生1例围手术期死亡（术后29天）。4例患者需要气管切开术。在平均32.4个月的随访期间，有49例晚期死亡，主要是由于恶性疾病。所有术后30天存活的204例患者在最后一次随访检查时或因与重建手术无关的原因死亡时，手术效果均极佳。
