Yamaoka N, Uchiyama T, Nakamura A, Ide S, Yamashita H, Yamauchi H, Yamaguchi H, Hashizume K
Department of Thoracic Surgery, Oita Prefectural Hospital, Japan.
Kyobu Geka. 1996 Jan;49(1):8-12.
Reconstruction of full-thickness chest wall defects after the total layer resection of the chest wall has been performed on 6 cases. Five of 6 cases had local recurrent of breast carcinoma, one case had a recurrent liposarcoma in the chest wall. The reconstruction procedure of skeletal chest wall used to double soft Marlex mesh. The soft tissue layer of the chest wall was reconstructed with myocutaneous flaps in five cases (four cases using latissimus dorsi, one case using rectus abdominis), with omental pedicle graft and free skin flap in one case. Minor wound complications occurred in 2 in the 6 cases, one case had myocutaneous flap using rectus abdominis, the other case using omental pedicle flap, but any postoperative complications including respiratory insufficiency was not seen with myocutaneous flap using latissimus dorsi. The latissimus dorsi myocutaneous flap was most suitable to cover the soft tissue layer of the chest. We confirmed that Marlex mesh and latissimus dorsi myocutaneous flap were able to reconstructed for large defects of full-thickness chest wall involving the sternum, there were best approach to reconstruction full-thickness chest wall defects after total layer chest wall resection.
对6例患者进行胸壁全层切除术后重建全层胸壁缺损。6例中有5例为乳腺癌局部复发，1例为胸壁脂肪肉瘤复发。胸壁骨骼重建采用双层软质Marlex网片。5例胸壁软组织层采用肌皮瓣重建（4例用背阔肌，1例用腹直肌），1例采用带蒂大网膜移植和游离皮瓣。6例中有2例出现轻微伤口并发症，1例使用腹直肌肌皮瓣，另1例使用带蒂大网膜瓣，但使用背阔肌肌皮瓣未见包括呼吸功能不全在内的任何术后并发症。背阔肌肌皮瓣最适合覆盖胸部软组织层。我们证实，Marlex网片和背阔肌肌皮瓣能够重建累及胸骨的全层胸壁大缺损，是胸壁全层切除术后重建全层胸壁缺损的最佳方法。
