Chest wall defect repair and reconstruction

Thoracic wall trauma or massive chest wall defect after removal of the chest wall tumor requires repair and reconstruction of the chest wall. Thoracic wall reconstruction is required for bone wall defects of 6cm×6cm. Generally, autologous tissue can be used. If necessary, metal stents can be added. Large-area defects (10cm×10cm or more) are ideal for Sanwenzhi repair. Skin soft tissue defects can be repaired. The latissimus dorsi flap and the breast cleft palate. Treatment of diseases: chest wall soft tissue tumor chest wall soft tissue injury Indication Patients with chest wall trauma or large chest wall defects after removal of chest wall tumors. Preoperative preparation Antibiotics are routinely used before surgery. Surgical procedure Repair of the soft tissue layer of the chest wall: it can be directly sutured or transferred by adjacent flaps; it is very suitable for the transfer of breast flaps in female patients. Non-breast cancer patients can use the ipsilateral breast to loosen and displace the wound. If one side of the breast is absent, the contralateral breast cleft palate can also be used to repair the wound on the chest wall. It is simple and effective, but if the breast is displaced, if the appearance is too large, especially the latter may move the nipple to the chest. Near the line, young women should be avoided as much as possible during non-palliative surgery. The latissimus dorsi flap has a very important position in the repair of chest wall defects. The maximum available tissue area can reach 35cm×18cm. The island latissimus dorsi flap with neurovascular pedicle is often used for metastasis through the subcutaneous tunnel. The repair of all the defects in the lateral chest wall, and the musculocutaneous flap has sufficient thickness and sensory nerves, and the repair effect is very satisfactory. The repair of the bony chest wall: the key is the stability of the chest wall, a certain tensile strength, play a protective role for the internal organs of the chest, and maintain the negative pressure of the chest. It is generally believed that the defect area is 6cm × 6cm, and the rib defect is more than 2, and chest wall reconstruction should be performed. For the defect of the posterior chest wall, due to the protection of the scapula and thicker muscle layer, the minimum required reconstruction area can be expanded to 10cm×10cm. Methods include the use of autologous or allogeneic tissue, metallic materials and synthetic materials. Autologous tissue including fascia lata, muscle flap, omentum, patella, ribs, etc., although considered to be the most suitable repair material for human physiology, but limited in material, increased trauma, and most of the hardness is not enough, more suitable for area Repair of minor defects. The metal materials mainly include metal wire, mesh and plate. The titanium alloy is the most ideal, the tissue compatibility is good, the repair is simple and convenient, and the strength is also strong. The combination of the self-propelled fascia film and the synthetic fiber sheet can achieve better results, but Repair of large area defects is not ideal, and metal materials are not conducive to postoperative X-ray examination and radiotherapy. In particular, the influence of the metal plate is greater, and the fixing is difficult and easy to loose. Synthetic materials include nylon, plastic, plexiglass, Dacron, Marlex, etc. Dacron and Marlex are used at present. The method is simple and the compatibility is good, but the tensile strength is still insufficient, and there is a large area of defect repair. limit. The current best repair method for bony chest wall defects is the Marlex+bone cement+Marlex sandwich healing method reported by Mc Cormack et al. complication Local effusion (the pressure is applied after pumping), the titanium alloy sheet is loosely infected.

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