Eschapasse H, Gaillard J, Henry F, Fournial G, Berthoumieu F, Desrez X
Ann Thorac Surg. 1981 Oct;32(4):329-36. doi: 10.1016/s0003-4975(10)61753-5.
The repair of large chest wall defects has been done on 23 patients who had 28 operations. Twenty-two patients had a neoplasm of the thoracic cage, while 1 had a large inflammatory mass. Nine patients had a partial lung and 3 a partial diaphragmatic resection done en bloc with the ribs. Seven resections were on the sternum. The repair was made either with a soft prosthesis (nylon mesh in 3 and Marlex mesh in 12 operations) or with a composite prosthesis of methyl methacrylate and metallic or Marlex mesh (13 operations). The association of methyl methacrylate and Marlex combines the solidity and the easy shaping of methyl methacrylate with the advantages of the mesh for an easy fixation and excellent incorporation. When the skin and the muscles are resected with the osteocartilaginous wall, an omentum flap is placed between the skin and the prosthesis to facilitate healing. There was one postoperative wound infection, which cleared with appropriate antibiotics. No prosthesis has extruded. The cosmetic and functional results are satisfactory. Repair of very large chest wall defects after resection can be done safely.
对23例患者进行了28次手术，修复大面积胸壁缺损。22例患者患有胸廓肿瘤，1例有巨大炎性肿块。9例患者行肺部分切除术，3例患者行膈肌部分切除术并同时切除肋骨。7例切除术涉及胸骨。修复采用软质假体（3例使用尼龙网，12例使用Marlex网）或甲基丙烯酸甲酯与金属或Marlex网的复合假体（13例手术）。甲基丙烯酸甲酯与Marlex的联合使用结合了甲基丙烯酸甲酯的坚固性和易于塑形的特点以及网片便于固定和良好融合的优点。当皮肤和肌肉与骨软骨壁一起切除时，在皮肤和假体之间放置大网膜瓣以促进愈合。术后有1例伤口感染，经适当抗生素治疗后痊愈。无假体脱出。美容和功能效果令人满意。切除术后大面积胸壁缺损的修复可以安全进行。
