It is reported in this paper that defect of chest wall of dogs were repaired by hetcrotransplantation of pig bone. The shape of original chest wail were achieved following operation. Histologic study showed that the grown between trabeculae with immersion that method is not only to have same function of other reparing materials,but there is no rejection.
ObjectiveTo explore the surgical treatment of deep chest wall infection, improve the cure rate and reduce the recurrence rate.MethodsThe clinical data of 655 patients with deep chest wall infection treated in Yanda Hospital and Beijing Royal Integrative Medicine Hospital from June 2015 to June 2020 were retrospectively analyzed. There were 450 males and 205 females, aged 55.6±12.8 years. There were 8 patients with chest wall infection after tumor necrosis, 15 patients after radiotherapy and 632 patients after thoracotomy (612 patients after cardiovascular surgery and 20 patients after general thoracic surgery). Among them, 649 patients underwent debridement and reconstruction of chest wall defect with muscle flap.ResultsThe average operation time was 95±65 min, the average intraoperative blood loss was 180±100 mL, and the average postoperative hospital stay was 13±6 d. Of the 649 patients who underwent muscle flap reconstruction after debridement, 597 patients recovered within 2 weeks, and the primary wound healing rate was 94.4%. Twenty-three (3.5%) patients died. The median follow-up time was 25 (2-40) months. Among the remaining 632 patients, 20 recurred, with a recurrence rate of 3.1% (20/632).ConclusionPedicled muscle flap after thorough debridement of deep chest wall infection is one of the best methods to repair chest wall defect with pedicled muscle flap.
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.
Lung segmentation is the premise of the computer aided diagnosis of lung cancer. The traditional segmentation method based on local low-level features can not get the correct result when a tumor is connected with pleura due to their similar computed tomography (CT) values. Moreover, because the big size of tumor leads to the loss of a large part of lung area, the traditional segmentation methods of lung with juxta-pleural nodule whose diameter is less than 3 cm are not suitable. Acitve shape model (ASM) combined with prior shape and low level features might be appropriate. But the search steps in conventional ASM is an optimization method based on the least square, which is sensitive to outlier marker points, and it makes profile update to the transition area of normal lung tissue and tumor rather than a true lung contour. To solve the problem, we proposed an improved ASM algorithm. Firstly, we identified these outlier marker points by distance, and then gave the different searching functions to the abnormal and normal marker points. And the search processing should be limited in volume of interesting (VOI). We selected 30 lung images with juxta-pleural tumors, and got the overlap rate with the gold standard as 93.6%. The experimental results showed that the improved ASM could get good segmentation results for the lungs with juxta-pleural tumors, and the running time of the algorithm could be tolerated in clinical.
Objective To evaluate the results of chest wallreconstruction (CWR) in patients who underwent chest wall tumor resection accompanying huge chest wall defect. Methods From Jan. 1998 to Mar. 2003, 31 patients underwent CWR. Among them, 20 were male and 11 female. The age ranged from 8 to 72 years.The indications for resection were primary chest wall tumor in 21 patients, lung cancer with invasion of chest wall 6, recurrence of breast cancer 2, radiationnecrosis 1 and skin cancer 1. The number of rib resected was 2~7 ribs (3.6 in average). The defect was 20~220 cm2 (97.1 cm2 in average). Concomitant resectionwas done in 13 patients, including lobectomy or wedge resection of lung 10, partial resection of diaphragm 2, and partial sternectomy 1. Seven patients underwent soft tissue reconstruction alone(latissimus dorsi+greater omentum, latissimusdorsi myocutaneous flap, latissimus dorsi muscle flap), 5 patients bony reconstruction alone(Prolen web), and simultaneous BR and STR were performed in 19 patients(latissimus dorsi, pectorails major, latissimus dorsi+fascia lata, and Prolene web). Results Three patients (9.7%) developed postoperative complications. Postoperative survival period was 6~57 months with a median of 22 months. Conclusion A favorable clinical outcome can be achieved by CWR for the patients with hugechest wall defects that result from resection of chest wall tumors.
ObjectiveTo explore the practical feasibility of the weaving technique for pectus carinatum.MethodsFrom January 2011 to December 2018, a total of 51 patients with pectus carinatum, including 47 males and 4 females at age of 9-29 (13.7±2.9) years, were applied with minimally invasive waving technique for the correction. The steel plate was inserted through the subcutaneous layer, intercostal space and over the sternal surface under direct thoracoscopic vision. The number of implanted steel plates was determined by the degree of chest wall deformity. The steel plate was removed 2 years after surgery.ResultsAll the operations were successfully completed, the average operation time was 63.9±15.8 min, the amount of bleeding was 19.8±8.8 mL, and the duration of postoperative hospitalization was 4.6±1.6 d. The adverse events included intercostal artery injury (n=2), pneumothorax (n=4), pleural effusion (n=3) and skin rupture (n=1). And there were 29 patients of moderate pain (numerical rating scale 4-6 points) on the first day after surgery, but no patient was asked to remove the steel palate due to intolerable discomfort. All patients were followed up after plate placement. Of the 51 patients, the plates were removed in 37 patients until 2 years after placement, and the duration of postoperative hospitalization was 1.4±0.5 d. After 33 (1-48) months of routine follow-up after the removal of the plate, 22 patients achieved excellent outcomes and 9 patients with good outcomes. Besides, there were 5 patients with fair outcome and 1 patient with poor outcome. No adverse effect was found in growth and development after the steel plate placement.ConclusionMinimally invasive weaving technique is a safe, feasible, effective and individualized operation for pectus carinatum with substantial thoracic reconstruction.
目的:探討開胸心臟瓣膜替換術后胸壁瘺及慢性化膿性肋軟骨炎的處理方法。方法:對單根的肋軟骨炎并胸壁瘺者,在壓痛最明顯處直接切除受累的肋軟骨及竇道組織;對伴瘺的胸部多根肋軟骨炎,可在經胸壁相對正常處切開,建立以遠離感染部位為蒂的開放胸部皮瓣,經瘺口加壓注入美藍使受累的肋軟骨及壞死筋膜染色,沿染色部完整切除受累的肋軟骨及筋膜、瘺管周圍組織;在手術創面皮瓣下置放盆式多孔引流管,術后持續低負壓吸引,選用敏感抗生素。結果:本組3例,術后6天撥管,10天后傷口愈合,效果良好。結論:經正常皮膚切口入路,建立開放胸壁皮瓣,徹底清除感染壞死的肋軟骨及瘺管周圍組織是治療開胸心臟換瓣術后胸壁瘺及慢性化膿性肋軟骨炎的可靠方法。
Over a two year period, four patients of pectus carinatum received surgical correction at our hospital. All patients were followed up for 6 months to 1 year. The operative results were satisfactory but one required revision with additional resection of bilateral second cartilage for the persistent malformation. The clinical characteristics, operative techniques and indications for operative treatment were discussed.
Surgical management of non-small cell lung cancer (NSCLC) invading chest wall is the combination of pulmonary resection, lymphadenectomy and chest wall resection and reconstruction. Hitherto the surgical procedures include combination of thoracotomy and video-assisted thoracoscopic surgery (VATS), thoracotomy, and VATS. The result of the surgery leads to a defect in the chest wall. Therefore, the requirements of the technique and material are relatively high with no consensual standard. This review describes the definitions, indications, materials, prognostic factors, and recent progress in surgical techniques.