Abstract： Objective To summarize the application experience of Gore-Tex patch in clinical chest wall reconstruction. Methods A retrospective analysis was performed in 33 patients who underwent chest wall reconstruction using Gore-Tex patch from January 2001 to December 2010 in Shanghai Changhai Hospital, Second Military Medical University. There were 19 men and 14 women, ranging in age from 20 to 73 years with a median age of 45.7 years. The surgical strategies included choosing different incisions according to tumor location and size, and preserving normal chest wall soft tissue as much as possible during surgery. Gore-Tex patch was used to reconstruct the huge chest wall defect, and covered by transferred muscle flaps. Results All the 33 patients underwent surgical reconstruction successfully and there was no perioperative death. Complete tumor resection was performed in all the patients, including 25 patients with malignant tumor and 8 patients with benign tumor. The diameter of the resected tumors ranged from 8 to 20 cm. All the patients were followed up from 5 to 60 months, except that 3 patients （9.09%） were lost during follow-up. There was no rejection response, abnormal breathing and foreign body sensation during follow-up. The infection incidence was 3%（1/33）. Conclusion Gore-Tex patch is a safe and effective material for chest wall reconstruction due to its excellent biocompatibility. Appropriate selection of muscle flap for covering Gore-Tex patch can reduce postoperative complications.
Objective To investigate the surgical techniques and effectiveness for reconstruction of severe full-thickness chest wall defects. Methods Between January 2006 and December 2010, 14 patients with full-thickness chest wall defects were treated, including 12 cases caused by giant chest wall mal ignant tumor excision, 1 case by thermocompression injury, and 1 case by radiation necrosis. There were 8 males and 6 females with an average age of 42 years (range，23-65 years). The size of chest wall defects ranged from 8 cm × 5 cm to 26 cm × 14 cm. All patients compl icated by rib defect (1-5 ribs), and 3 cases by sternum defect. Thoracic skeleton reconstruction was performed with Vicryl mesh or polytetrafluroethylene mesh in 10 patients. Other 4 patients did not undergo thoracic skeleton reconstruction. The bilobed skin flaps, pectoral is major myocutaneous flap, latissimus dorsi myocutaneous flap, and rectus abdominis myocutaneous flap were util ized for repairing soft tissue defects. The size of the dissected flaps ranged from 10 cm × 7 cm to 25 cm × 13 cm. The donor sites were sutured directly or were repaired by free skin graft. Results Poor heal ing of incision occurred in 2 cases, which was cured after debridement, myocutaneous flap transfer, and skin graft. The other wounds healed by first intention. All patients were followed up 6-36 months (mean, 8 months). No tumor recurrence during follow-up, except 1 patient with osteosarcoma who died of l iver matastasis at 6 months after operation. Transient sl ight paradoxical respiration occurred in 1 patient who did not undergo thoracic skeleton reconstruction at 5 days after operation. Integrity of chest wall in other patients was restored without paradoxical respiration and dyspnea. Conclusion Depending on the cause, the size, and the location of defect, single or combination flaps could be used to repair soft tissue defect, and thoracic skeleton reconstruction should be performed when defect is severe by means of syntheticmaterials.
Objective To observe an early result after the repair of the large upper thoracic wall defect by a combined use of the titaniumnet, reconstruction nickelclad, and latissimus dorsi myocutaneous flap in a patient who underwent a breast sarcomatoid caricinoma resection on the upper thoracic wall. Methods A breast sarcomatoid carcinoma in the upper thoracic wall was removed in 1 56yearold female patient in February 2006. After the tumorectomy, a large thoracic wall defect was left, which was 20cm×15cm in size. The defect was covered by the titanium net, the bilateral stumps of the clavicles were connected by the reconstruction nickelclad, and the soft tissue defect was repaired with the right latissimus dorsi myocutaneous flap(20cm×15cm). Results The patient depended on the breathing machine for 3 days after operation. When the breathing machine was discontinued, the patient developed a severe paradoxical breathing. Two weeks after operation when theblood circulation of the flap was stabilized, the paradoxical breathing disappeared with the help of the chest bandage for fixation of the chest cavity, and the blood supply of the flap was improved. The chest X-ray film showed that the titanium net and the reconstruction nickelclad were well positioned. The patient received chemotherapy 1 month after operation, The follow-up for 3 months revealed that the patient’s local condition and physical condition were good, and ROMof both the shoulders was improved, with AF 90° and ABD 90°. No recurrence ofthe tumor was found. Conclusion A large thoracic wall defect should be repaired with solid materials. The normal anatomic locations of the clavicles should be maintained with fixation by the reconstruction nickelclad for a good function of the shoulders. The latissimus dorsi myocutaneous flap can be properly enlarged.
Objective To evaluate the biocompatibility and in vivo degradation of novel chest wall prosthesis materials and provide some data for their clinical application. MethodsAccording to the standard for the biological evaluation of the medical devices, several tests were performed to evaluate the tissue toxic effects induced by polydioxanone (Group A), chitosan (Group B), and hydroxyapitite/collagen (Group C),which were tested as component materials of the chest wall prosthesis. In the hemolysis test, 0.2 ml of the anticoagulant rabbit blood was added to the component materials and the normal saline (negative control) and to the distilled water(positive control). Five samples were made in each group. Absorbency was measured and the hemolysis rate was determined. In the acute systemic toxicity test, 20 mice were randomly divided into 4 groups (Groups A, B and C, and the normal saline group, n=5). The leaching liquid (50 ml/kg) was injected through the caudal vein, which was observed at 24, 48 and 72 hours. In the pyrogen test, 12 rabbits were randomly divided into 4 groups (Groups A, B, C and the normal saline group, n=3) the leaching liquid(10 ml/kg) was injected through the ear vein,and the body temperature was recorded within 3 hours. In the in vivo degradable test, the component materials (10 mm×10 mm) were implanted in 12 rabbits at 2, 4, 8, 12, 16 and 24 weeks, respectively, after operation. Two rabbitswere sacrificed for the macroscopic and the microscopic examinations. Results The chest wall component materials had no hemolytic reaction, no acute systemic toxicity, and no pyrogen reaction. The results demonstrated that the implanted materials had only a mild inflammatory reaction during the early days of the grafting, which subsided gradually. There was no tissue denaturation, necrosis or pathological hyperplasia when the prosthesis materials were degraded. Conclusion The degradable materials of the chest wall prosthesis have a good biocompatibility and agreat biological safety though their surgical application still requires a further clinical research.
Objective To evaluate the application value of repairing the defects of the chest wall with the thoracico-abdominal skin flap and the muscle flap of the musculus rectus abdominis. Methods From January 2002 to June 2005, five patients with defects in the chest wall underwent the prothesis with the thoracico-abdominal skin flap and the muscle flap of the musculus rectus abdominis under general anesthesia. Focal cleaning was performed first; then, the skin flap was designed and taken (15 cm ×10 cm); and finally, the defects of the chest wall were repaired with the muscle flap of the musculus rectus abdominis. Results Of the 5patients, 4 had the flap healing by the first intention, and 1 had the delayed healing, with no complication. The skin flap had a good appearance, without edema orpigmentation. The X-ray examination showed that the shadow of the sternal sequestrum disappeared. There was no recurrence or complication during the follow-upfor 1-3 years (average, 18 mon). Conclusion The repairing of the defects in the chest wall with the thoracico-abdominal skin flap and the muscle flap of the musculus rectus abdominis is a simple and effective surgical treatment for defects of the chest wall around the sternum, and this kind of treatment is worth applying extensively in clinical practice.