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 construct a nursing quality evaluation indicator system for patients with skin flap transplantation and to provide a reference for the evaluation and continuous improvement of nursing quality in patients with skin flap transplantation. Methods With the three-dimensional quality structure theory as the theoretical framework, the nursing quality evaluation indicator system for patients with skin flap transplantation and indicator weights were established through literature review, expert meeting, Delphi method, and analytic hierarchy process. From October to December 2025, clinical application was carried out in departments performing flap transplantation surgeries nationwide to verify the feasibility and practicality of the indicator system. Results Two rounds of expert consultations were conducted. The expert authority coefficients were 0.941 and 0.950, respectively. The mean importance scores of all indicators were >3.50, the variation coefficients were <0.25, and the full-score rates were >20.00%. Kendall’s coefficients of concordance were 0.122 and 0.153 (P＜0.05), respectively. The final nursing quality evaluation indicator system for patients with skin flap transplantation included 3 primary indicators, 7 secondary indicators, and 18 tertiary indicators. A total of 50 departments participated in the preliminary clinical application. The Cronbach’s α coefficient of the indicator system was 0.821, the Spearman-Brown coefficient for split-half reliability was 0.773, the average content validity index of the indicator system was 0.99, and the universal content validity index was 0.83. The satisfaction questionnaire score was 21.86±2.26. Conclusion The nursing quality evaluation indicator system for patients with skin flap transplantation is feasible and practical, reflects the disease-specific characteristics of skin flap transplantation, and can be used for nursing quality management in patients with skin flap transplantation.