Gebremariyam Zenebe Teklu, Woldemariam Samuel Tesfaye, Beyene Tesfaye Dejene, Baharu Lensa Million
Jimma University Medical Center, Jimma University, Ethiopia.
Jimma University Medical Center, Jimma University, Ethiopia.
Int J Surg Case Rep. 2024 Apr;117:109496. doi: 10.1016/j.ijscr.2024.109496. Epub 2024 Mar 11.
Chest wall tumors, rare but impactful, constitute less than 2 % of the population and 5 % of thoracic neoplasms. Wide-margin resection is vital, often causing substantial defects necessitating reconstruction. However, in resource-limited settings like sub-Saharan Africa, access to reconstruction materials is limited. We present a successful case of managing a massive chest wall defect using flexible wire and polypropylene mesh in such a context.
A 40-year-old male presented with a gradually enlarging anterolateral chest wall mass, diagnosed as low-grade synovial sarcoma. Imaging revealed involvement of the 6th to 11th ribs with compression of the diaphragm and liver. A multidisciplinary team planned wide-margin excision, chest wall reconstruction, and adjuvant chemoradiation. Using a sternal wire bridge and polypropylene mesh, the 25 cm by 15 cm defect was reconstructed, covered with a latissimus dorsi flap. The patient recovered well postoperatively, highlighting the feasibility of innovative approaches in resource-limited settings.
Defects larger than 5 cm or involving over 4 ribs require reconstruction to prevent lung herniation and respiratory issues, especially for anteriorolateral defects. Our case featured a 25 by 15 cm anteriorolateral chest wall defect, necessitating rigid reconstruction. Due to resource constraints, we utilized flexible wires and polypropylene mesh, offering a cost-effective solution for managing massive chest wall defects.
This case underscores the challenges faced in managing chest wall tumors in resource-constrained regions and emphasizes the importance of innovative solutions for achieving successful outcomes in chest wall reconstruction.
胸壁肿瘤虽罕见但影响重大，占人口比例不到2%，占胸部肿瘤的5%。广泛切缘切除至关重要，这常导致巨大缺损，需要进行重建。然而，在撒哈拉以南非洲等资源有限的地区，获得重建材料的途径有限。我们在此介绍一个在这种情况下使用柔性钢丝和聚丙烯网成功处理巨大胸壁缺损的病例。
一名40岁男性因前外侧胸壁肿物逐渐增大前来就诊，诊断为低级别滑膜肉瘤。影像学检查显示第6至11肋骨受累，伴有膈肌和肝脏受压。一个多学科团队计划进行广泛切缘切除、胸壁重建及辅助放化疗。使用胸骨钢丝桥和聚丙烯网，对25厘米×15厘米的缺损进行了重建，并用背阔肌肌皮瓣覆盖。患者术后恢复良好，凸显了在资源有限环境中创新方法的可行性。
大于5厘米或累及超过4根肋骨的缺损需要进行重建以防止肺疝形成和呼吸问题，尤其是对于前外侧缺损。我们的病例为一个25厘米×15厘米的前外侧胸壁缺损，需要进行刚性重建。由于资源限制，我们使用了柔性钢丝和聚丙烯网，为处理巨大胸壁缺损提供了一种经济有效的解决方案。
该病例强调了在资源受限地区处理胸壁肿瘤所面临的挑战，并强调了创新解决方案对于胸壁重建取得成功结果的重要性。
