Granick M S, Larson D L, Solomon M P
Department of Plastic and Reconstructive Surgery, Medical College of Wisconsin, Milwaukee.
Clin Plast Surg. 1993 Jul;20(3):559-71.
Irradiation-associated chest wall lesions pose a significant health hazard to the patient. The principles of management include (1) biopsy of any open wounds to rule out the recurrence or persistence of tumor, (2) aggressive debridement of all offending tissues, and (3) reconstruction with well-vascularized flap tissue. Numerous questions arise regarding the practical management of these patients. The controversies that have arisen during our management of more than 100 of these patients have been discussed. It is appropriate to perform reconstruction following nonhealing of a superficial ulcer or immediately following the excision of a full-thickness chest wall defect. Hyperbaric oxygen can serve as a useful adjunct. It is rarely necessary to use a prosthetic material for the purpose of chest wall stabilization during the reconstruction of full-thickness defects. Paradoxic chest wall movement in the postoperative period does not significantly affect pulmonary function tests and is generally a transient problem. Subtotal excisions are frequently necessary. As long as all of the necrotic or tumor-bearing tissue has been fully removed, these wounds can be expected to heal in most instances by placing vascularized tissue into the defect. Operative sites in previously irradiated chest wall tissue can be expected to heal if proper and careful surgical technique is employed. Nevertheless, there is a risk of wound breakdown following any surgery in irradiated tissue. Finally, we believe it is appropriate to proceed with aesthetic recontouring of chest wall deformities associated with irradiation exposure.
放疗相关的胸壁病变对患者构成重大健康危害。处理原则包括：（1）对任何开放性伤口进行活检，以排除肿瘤复发或持续存在；（2）积极清除所有病变组织；（3）用血运丰富的皮瓣组织进行重建。关于这些患者的实际处理出现了许多问题。我们讨论了在处理100余例此类患者过程中出现的争议。在浅表溃疡不愈合后或全层胸壁缺损切除后立即进行重建是合适的。高压氧可作为一种有用的辅助手段。在全层缺损重建过程中，为稳定胸壁而使用假体材料的情况很少见。术后反常胸壁运动对肺功能测试影响不大，通常是一个短暂问题。经常需要进行部分切除。只要所有坏死或含肿瘤组织已被完全清除，在大多数情况下，通过将带血管组织置入缺损处，这些伤口有望愈合。如果采用恰当且仔细的手术技术，先前接受过放疗的胸壁组织的手术部位有望愈合。然而，在放疗组织中进行任何手术后都存在伤口裂开的风险。最后，我们认为对与放疗相关的胸壁畸形进行美学重塑是合适的。
