Thoraxwandrekonstruktion

Summary

In cases of malignant disease of the chest wall, such as primary tumors or extensive metastases, a particularly large resection is necessary. This leads to great problems in restoring an adequately functional chest wall. In addition to the cosmetic effect one must pay particular consideration to the dynamic parameters of pulmonary function.

In a 54 years old male suffering from recurrent malignant shwannoma we performed an extensive chest wall resection. It included the ribs 3-8 on the right. The extension of the defect was 15 × 22 cm. We reconstructed the pleura with Vicryl [1] -mesh. The covering was done with musculus pectoralis major, musculus rectus abdominis and a musculocutaneous obliquus externus abdominis flap. Three months after operation a small restriction of vital capacity is observed. In a 29 years old male partial resection of the right chest wall had to be done for a local extended chondro-sarcoma. The tumor included the ribs 4-9: chest wall defect after resection amounted to 15 × 18 cm. We performed a primary reconstruction using Vicryl [1]-mesh as substitute for the pleura. We covered the pleura with a musculocutaneous latissimus dorsi flap. Three months after successful reconstruction the parameters of pulmonary function reached normal values again.

In these and further cases the combination of Vicryl [1]- mesh as a resorbable substitute for the pleura and musculocutaneous flaps for the chest wall has been successful in restoring a good pulmonary function.

Zusammenfassung

Vor allem bei transmuralen malignen Erkrankungen der Thoraxwand (primäre Malignome und Metastasen) ist oftmals eine weiträumige Thoraxwandresektion aus Gründen der Radikalität unumgänglich. Die rekonstruktiven Maßnahmen müssen neben kosmetischen Aspekten vor allem im Bereich der lateralen Thoraxwand funktionelle Gesichtspunkte berücksichtigen.

Es werden zwei Kasuistiken vorgestellt, wo jeweils wegen maligner Prozesse der Thoraxwand weiträumige laterale Thoraxwandresektionen erforderlich gewesen waren. Zur primären Thoraxwandstabilisierung war als Pleuraersatz ein gedoppeltes resorbierbares Vicrylnetz eingenäht worden, das vollständig durch myokutane Lappen plastiken gedeckt worden war. Neben einem guten kosmetischen Ergebnis haben wir bei den Nachuntersuchungen drei Monate postoperativ auch ein gutes funktionelles Ergebnis feststellen können.

Key words

Chest wall tumors - chest wall defect - chest wall reconstruction

1 Vicryl: a product of Ethicon, Hamburg

1 Vicryl: a product of Ethicon, Hamburg