Sternal Resections: An Attempt to Find the Ideal Reconstruction Method.

IF 2.4 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Emanuel Palade, Ioana-Medeea Titu, Lucian Fodor, Ion Mircea Ciorba, Ion Jentimir, Florin Teterea, Monica Mlesnite, Ioana Tichil
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引用次数: 0

Abstract

Background and Objectives: Sternal resections, although rare, pose significant challenges for the reconstruction of large anterior chest wall defects. Both stability and soft tissue reconstruction are essential for preventing respiratory complications and ensure structural stability. Despite the variety of techniques proposed, no consensus exists on an optimal method. Herein, we present our institutional experience using the novel "spider-web" technique combined with an anterolateral thigh (ALT) free flap for chest wall and soft tissue reconstruction following extensive sternectomies. Materials and Methods: Between January 2023 and November 2024, five female patients underwent partial or total sternectomy for oncologic indications. Chest wall stability was restored using the "spider-web" technique-based on non-resorbable polyester threads arranged in a geometric web pattern reinforced with polypropylene mesh-followed by soft tissue reconstruction using a free ALT myocutaneous flap. Data on demographics, surgical details, postoperative outcomes, and complications were prospectively analyzed. Results: Resections included two partial and three total sternectomies. The mean operative time was 385 min (range: 330-435 min). All patients were extubated postoperatively without the need for respiratory support. The "spider-web" construct provided adequate chest wall stability with no cases of paradoxical movement or chronic pain. No flap loss occurred; one case required revision for venous thrombosis, and one hematoma at the donor site was evacuated. No infections or wound dehiscence were observed. The median hospital stay was 11 days (SD ± 1.67 days), and 30-day mortality was 0%. Median follow-up was 10 months (SD ± 6.55 months), without long-term complications. Conclusions: The "spider-web" technique, combined with ALT myocutaneous free flap, is a simple, reliable, and cost-effective method for the reconstructing extensive chest wall defects following sternectomy. Its technical versatility and favorable outcomes suggest it as a valuable option, offering both structural stability and soft tissue coverage with minimal morbidity.

胸骨切除术:寻找理想重建方法的尝试。
背景与目的:胸骨切除术虽然罕见,但对胸壁前壁大面积缺损的重建提出了重大挑战。稳定性和软组织重建对于预防呼吸并发症和确保结构稳定性至关重要。尽管提出了各种各样的技术,但在最佳方法上没有达成共识。在此,我们介绍了我们使用新型“蜘蛛网”技术结合股骨前外侧游离皮瓣进行胸壁和软组织重建的机构经验。材料和方法:在2023年1月至2024年11月期间,5例女性患者因肿瘤指征接受了部分或全部胸骨切除术。使用“蜘蛛网”技术恢复胸壁稳定性,该技术基于不可吸收的聚酯线以聚丙烯网增强的几何网状结构排列,然后使用游离ALT肌皮瓣重建软组织。前瞻性分析人口统计学数据、手术细节、术后结果和并发症。结果:包括2例部分胸骨切除术和3例全胸骨切除术。平均手术时间385 min(范围330 ~ 435 min)。所有患者术后均拔管,无需呼吸支持。“蜘蛛网”结构提供了足够的胸壁稳定性,没有矛盾运动或慢性疼痛的病例。无皮瓣损失;一例因静脉血栓需要翻修,一例供体部位血肿被清除。未见感染或创面裂开。中位住院时间为11天(SD±1.67天),30天死亡率为0%。中位随访10个月(SD±6.55个月),无长期并发症。结论:“蜘蛛网”技术联合ALT肌皮瓣是胸切除术后广泛胸壁缺损重建的一种简单、可靠、经济的方法。它的技术通用性和良好的结果表明它是一个有价值的选择,提供结构稳定性和软组织覆盖,发病率最低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Medicina-Lithuania
Medicina-Lithuania 医学-医学:内科
CiteScore
3.30
自引率
3.80%
发文量
1578
审稿时长
25.04 days
期刊介绍: The journal’s main focus is on reviews as well as clinical and experimental investigations. The journal aims to advance knowledge related to problems in medicine in developing countries as well as developed economies, to disseminate research on global health, and to promote and foster prevention and treatment of diseases worldwide. MEDICINA publications cater to clinicians, diagnosticians and researchers, and serve as a forum to discuss the current status of health-related matters and their impact on a global and local scale.
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