【作者】 郭伶俐； 叶祥柏； 邢新； 李军辉； 薛春雨； 毕宏达； 李志刚；

【Author】 Guo Lingli1,2,Ye Xiangbai3,Xing Xin1,Li Junhui1,Xue Chunyue1,Bi Hongla1,Li Zhigang4 1.Department of Plastic Surgery,Changhai Hispital, Second Military Mecical University,Shanghai,China. 2.Department of Plastic Surgery,General Military Hospital,Beijing,China. 3.Department of Plastic Surgery,Wulumuqi General Military Hospital,Wulumuqi,China. 4.Department of thoracic surgery,Changhai Hispital, Second Military Medical University,Shanghai,China.

【机构】 第二军医大学附属长海医院整形外科； 解放军总医院修复科； 兰州军区乌鲁木齐总医院烧伤整形科； 第二军医大学附属长海医院胸心外科；

【摘要】 目的:探讨胸壁全层缺损的修复方法。方法:15例患者因不同原因造成的胸壁全层组织缺损(男性9例,女性6例),其中胸壁恶性肿瘤12例、热压伤1例,爆炸伤1例,放射性损伤1例。经手术清创/肿瘤切除后,胸壁全层缺损面积约8cm×5cm～14cm×26cm,肋骨切除数量1到5根,部分胸骨切除3例,部分肩胛骨切除1例。胸壁缺损即刻修复13例,延期修复2例。应用涤纶网或PTFE修补胸廓缺损10例,未用人工材料修复5例。采用皮瓣或肌皮瓣进行胸壁软组织修复,其中,双叶皮瓣(1例),胸大肌肌皮瓣(3例),背阔肌肌皮瓣(6例),腹直肌肌皮瓣(3例),联合应用局部皮瓣和腹直肌肌皮瓣(1例),腹直肌肌皮瓣和胸大肌肌皮瓣(1例),术后随访1个月到36个月。结果:15例患者术后移植皮瓣或肌皮瓣全部成活,胸壁连续性恢复,无反常呼吸运动;X线平片示患侧肺扩张充分,通气功能良好。结论:根据胸壁缺损的病因,缺损面积和位置,单独或联合应用局部皮瓣或肌皮瓣能够有效修复严重的胸壁全层缺损,挽救患者生命。更多还原

【Abstract】 Objective:To discuss the surgical techniques for reconstruction of severe full -thickness chest wall defects.Methods:Full -thickness chest wall defects occurred in 15 patients(9 male,6 female) after giant chest wall tumor excision(12 patients),burn injury(1 patient), severe explosive injury(1 patient) and radiation necrosis(1 patient).The size of chest wall defects ranged from 8cm×5cm to 14cm×26cm.The number of ribs resected ranged from 1 to 5.3 patients underwent partial sternum resections and 1 patient underwent partial scapular resection. Immediate closure was performed in 13 patients,whereas delayed closure was performed in 2 patients.Primary repair with Vicryl mesh or PTFE was in 10 patients.Repair without synthetic material was in 5 patients.Flaps utilized for soft tissue coverage were bilobed skin flaps(1 patients ), major pectoris(3 patients),latissimus dorsi(6 patients), rectus abdominis myocutaneous flaps(3 patients), combined local skin flap and rectus abdominis myocutaneous flap(1 patient),combined major pectoris and rectus abdominis myocutaneous flap(1 ptatient ).Followup time was one to thirty-six months.Results:All the 15 patients healed uneventfully after skin flap grafting, integrity of chest wall was restored without paradoxical respiration.X-ray detection showed through lung extension on the affected side.Conclusions:Depending on factors such as the causes,the size of the defect,and location on the chest wall,a variety of flaps,single or in combination, could be used to achieve effectively coverage of the severe chest wall defect.更多还原