Sparreboom Cloë L, Hop M Jenda, Mazaheri Masood, Rothbarth Joost, Maat Alexander P W M, Corten Eveline M L, Mureau Marc A M
Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands.
JPRAS Open. 2024 Apr 18;41:14-24. doi: 10.1016/j.jpra.2024.04.006. eCollection 2024 Sep.
Reconstruction of full thickness chest wall defects is challenging and is associated with a considerable risk of complications. Therefore, the aim of this study was to investigate the surgical outcomes and their associations with patient and treatment characteristics following full thickness chest wall reconstruction.
A retrospective observational study was performed by including patients who underwent reconstruction of full thickness chest wall defect at the Erasmus MC between January 2014 and December 2020. The type of reconstruction was categorized into skeletal and soft tissue reconstructions. For skeletal reconstruction, only non-rigid prosthetic materials were used. Patient and surgical characteristics were retrieved and analyzed for associations with postoperative complications.
Thirty-two women and 10 men with a mean age of 60 years were included. In 26 patients (61.9%), the reconstruction was performed using prosthetic material and a soft tissue flap, in nine cases (21.4%) only a soft tissue flap was used, and in seven other patients (16.7%) only the prosthetic material was used. Pedicled musculocutaneous latissimus dorsi flaps were used most often (n=17), followed by pectoralis major flaps (n=8) and free flaps (n=8). Twenty-two patients (52.4%) developed at least one postoperative complication. Wounds (21.4%) and pulmonary (19.0%) complications occurred most frequently. Five (11.9%) patients required reoperation. There were no associations between patient and treatment characteristics and the occurrence of major complications. There was no mortality.
Reconstruction of full thickness chest wall defects using only non-rigid prosthetic material for skeletal reconstruction appears safe with an acceptable reoperation rate and low mortality, questioning the need for rigid fixation techniques.
全层胸壁缺损的重建具有挑战性，且伴有相当高的并发症风险。因此，本研究的目的是调查全层胸壁重建后的手术结果及其与患者和治疗特征的相关性。
进行了一项回顾性观察研究，纳入了2014年1月至2020年12月期间在伊拉斯姆斯医学中心接受全层胸壁缺损重建的患者。重建类型分为骨骼重建和软组织重建。对于骨骼重建，仅使用非刚性假体材料。检索并分析患者和手术特征与术后并发症的相关性。
纳入了32名女性和10名男性，平均年龄为60岁。26例患者（61.9%）使用假体材料和软组织瓣进行重建，9例（21.4%）仅使用软组织瓣，另外7例患者（16.7%）仅使用假体材料。带蒂背阔肌肌皮瓣使用最为频繁（n = 17），其次是胸大肌瓣（n = 8）和游离瓣（n = 8）。22例患者（52.4%）发生了至少一种术后并发症。伤口并发症（21.4%）和肺部并发症（19.0%）最为常见。5例（11.9%）患者需要再次手术。患者和治疗特征与严重并发症的发生之间无相关性。无死亡病例。
仅使用非刚性假体材料进行骨骼重建的全层胸壁缺损重建似乎是安全的，再次手术率可接受且死亡率低，这对刚性固定技术的必要性提出了质疑。
