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1.
Plast Reconstr Surg ; 145(5): 1275-1286, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332552

RESUMO

BACKGROUND: Oncologic resections involving both the spine and chest wall commonly require immediate soft-tissue reconstruction. The authors hypothesized that reconstructions of composite resections involving both the thoracic spine and chest wall would have a higher complication rate than reconstructions for resections limited to the thoracic spine alone. METHODS: The authors performed a retrospective analysis of all consecutive patients who underwent a thoracic vertebrectomy and soft-tissue reconstruction from 2002 to 2017. Patients were divided into two groups: those whose defect was limited to the thoracic spine and those who required a composite resection involving the chest wall. RESULTS: One hundred patients were included. Composite resection patients had larger defects, as indicated by a greater incidence of multilevel vertebrectomies (70.2 percent versus 17 percent; p = 0.001). Thoracic spine patients were older (58.2 ± 10.4 years versus 48.6 ± 13.9 years; p < 0.001) and had a greater incidence of metastatic disease (88.7 percent versus 38.3 percent; p = 0.001). Univariate and multivariate logistic regression analyses demonstrated that composite resections were not significantly associated with a higher rate of surgical, medical, or overall complications. Multivariate logistic regression analysis of composite resection subgroup demonstrated that flap separation of the spinal cord from the intrapleural space was protective against complications (OR, 0.22; 95 percent CI, 0.05 to 0.81; p = 0.03). CONCLUSIONS: Despite the large defect size in composite resection patients, there was no increase in complications compared to thoracic spine patients. In composite resection patients, separating the exposed spinal cord from the intrapleural space with well-vascularized soft tissue was protective against complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Osteotomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Parede Torácica/cirurgia , Toracoplastia/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia/métodos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Retalhos Cirúrgicos/transplante , Toracoplastia/efeitos adversos , Resultado do Tratamento
2.
J Cardiothorac Surg ; 15(1): 29, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31992336

RESUMO

BACKGROUND & OBJECTIVES: Primary chest wall sarcomas are rare and therapeutically challenging tumors. Herein we report the outcomes of a surgery-based multimodality therapy for these pathologies over an 11-year period. In addition, we present a case that illustrates the surgical challenges that extensive chest wall resection may pose. METHODS: Using the Society of Thoracic Surgeons general thoracic surgery database, we have prospectively collected data in our institute on all patients undergoing chest wall resection and reconstruction for primary chest wall sarcomas between June 2008-October 2019. RESULTS: We performed 28 surgical procedures on 25 patients aged 5 to 91 years (median age 33). Eleven tumors were bone- and cartilage-derived and 14 tumors originated from soft tissue elements. Seven patients (7/25, 28%) received neo-adjuvant therapy and 14 patients (14/25, 56%) received adjuvant therapy. The median number of ribs that were resected was 2.5 (range 0 to 6). In 18/28 (64%) of surgeries, additional skeletal or visceral organs were removed, including: diaphragm [1], scapula [2], sternum [2], lung [2], vertebra [1], clavicle [1] and colon [1]. Chest wall reconstruction was deemed necessary in 16/28 (57%) of cases, polytetrafluoroethylene (PTFE) Gore-Tex patches was used in 13/28 (46%) of cases and biological flaps where used in 4/28 (14%) of cases. R0, R1 and R2 resection margins were achieved in 19/28 (68%), 9/28 (32%) and 0/28 (0%) of cases, respectively. The median follow up time was 33 months (range 2 to 138). During the study period, disease recurred in 8/25 (32%) of patients. Of these, 3 were re-operated on and are free of disease. At date of last follow up, 5/25 (20%) of patients have died due to their disease and in contrast, 20/25 (80%) were alive with no evidence of disease. CONCLUSIONS: Surgery-based multimodality therapy is an effective treatment approach for primary chest wall sarcomas. Resection of additional skeletal or visceral organs and reconstruction with synthetic and/or biological flaps is often required in order to obtain R0 resection margins. Ultimately, long-term survival in this clinical scenario is an achievable goal.


Assuntos
Sarcoma/cirurgia , Neoplasias Torácicas/cirurgia , Parede Torácica/cirurgia , Toracoplastia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Recidiva Local de Neoplasia/cirurgia , Politetrafluoretileno , Próteses e Implantes , Reoperação , Retalhos Cirúrgicos , Toracoplastia/métodos , Resultado do Tratamento , Adulto Jovem
3.
Ann Thorac Surg ; 109(2): e95-e98, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31238031

RESUMO

A patient with extensive fibrocavitary pulmonary tuberculosis and extensively drug-resistant Mycobacterium tuberculosis underwent bilateral video-assisted thoracic surgery thoracoplasty. An examination 4 years post-surgery revealed that the patient was in a satisfactory condition and able-bodied. We performed surgery according to our proposed video-assisted thoracic surgery thoracoplasty technique. In the postoperative period, we noted early patient symptoms, including significantly less-pronounced pain than with standard incisions, the absence of limitations in upper limb mobility, and the absence of gross chest deformation. Permanent surgical collapse sufficient for closing cavities and the elimination of bacilli were achieved and confirmed with a computed tomography scan.


Assuntos
Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Toracoplastia/métodos , Tuberculose Pulmonar/terapia , Antituberculosos/uso terapêutico , Humanos , Masculino , Tuberculose Pulmonar/diagnóstico , Adulto Jovem
4.
Interact Cardiovasc Thorac Surg ; 30(1): 149-150, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31873742

RESUMO

Primitive malignant sternal tumours are extremely rare and represent less than 1% of all chest wall tumours. A combination of radical surgery and accurate reconstruction is mandatory to ensure adequate stability and to reduce paradoxical movement. To date, this is one of the few reports on a successful sternal reconstruction using a rigid titanium mesh to restore the skeletal integrity, which was then covered by bilateral muscular flaps.


Assuntos
Neoplasias Ósseas/cirurgia , Condrossarcoma/cirurgia , Esternotomia/métodos , Esterno , Telas Cirúrgicas , Toracoplastia/métodos , Titânio , Idoso , Neoplasias Ósseas/diagnóstico , Condrossarcoma/diagnóstico , Feminino , Humanos , Reoperação , Tomografia Computadorizada por Raios X
5.
BMC Surg ; 19(1): 187, 2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-31805919

RESUMO

BACKGROUND: In high-risk patients with complex pulmonary aspergilloma but unable for lung resection, cavernostomy and thoracoplasty could be performed. This study aimed to evaluate this surgery compared two compressing materials. METHODS: A total of 63 in high-risk patients who suffered from hemoptysis due to complex pulmonary aspergilloma and underwent cavernostomy and thoracoplasty surgery from November 2011 to September 2018 at Pham Ngoc Thach hospital were evaluated prospectively studied. Patients were allocated to two groups: the table tennis ball group and tissue expander group. We evaluated at the time of before operation, 6 months and 24 months after operation. RESULTS: Tuberculosis was the most common comorbidity diseases in both groups. Upper lobe occupied almost in location. Hemoptysis symptoms plunged from time to time. Statistically significant Karnofsky score was observed in both groups. Postoperative pulmonary functions (FVC and FEV1) have remained in both groups at all time points. The remarkable results were no deaths related to surgery and low complications both short and long-term. There was no statistical significance between two groups in operative time, blood loss during operation, ICU length-stay time. Four patients died because of co-morbidity in 24 months follow-up. CONCLUSION: Cavernostomy and thoracoplasty was safe and effective surgery for the treatment of complex pulmonary aspergilloma with hemoptysis in high-risk patients. No mortality related to surgery and low complications were recorded. The was no inferiority when compared two compressing materials .


Assuntos
Hemoptise/etiologia , Aspergilose Pulmonar/cirurgia , Toracoplastia/métodos , Adulto , Idoso , Feminino , Humanos , Tempo de Internação , Pulmão/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
6.
Spine Deform ; 7(6): 1003-1009, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31731992

RESUMO

INTRODUCTION: Pectus excavatum and scoliosis are associated conditions with a high rate of coincidence. However, there are no reports to guide surgeons on the management of adolescents with moderate scoliosis and pectus excavatum, because there are conflicting conclusions in the literature regarding how the Nuss procedure with substernal bar affects scoliosis. CASES: In 2017, we encountered two patients with moderate scoliosis treated with a spinal orthosis. After undergoing the Nuss procedure for pectus excavatum, their scoliosis acutely progressed into surgical magnitude requiring posterior instrumented spinal fusion. The first patient progressed 26° despite the pre-Nuss radiographs showing him to be Risser 4/5, while the second patient also progressed 26° from the Nuss procedure. Both patients acknowledged noncompliance with brace wear because of discomfort after the Nuss procedure. However, their progression rate still doubles the rate of reported rapid accelerators, indicating that a significant component of curve progression is directly attributed to forces on the spine from the corrective maneuver with substernal bar. CONCLUSION: The purpose of this case report is to describe the features of these two patients to help with clinical decision-making in patients with moderate scoliosis (curves >25°) who are contemplating the Nuss procedure for correction of pectus excavatum. We caution patients and providers that spinal deformity could worsen with surgical intervention of the pectus excavatum via the Nuss procedure and necessitate scoliosis surgery.


Assuntos
Tórax em Funil/cirurgia , Escoliose/cirurgia , Procedimentos Cirúrgicos Torácicos/métodos , Toracoplastia/efeitos adversos , Adolescente , Tomada de Decisão Clínica/ética , Progressão da Doença , Tórax em Funil/complicações , Humanos , Masculino , Aparelhos Ortopédicos/efeitos adversos , Aparelhos Ortopédicos/normas , Cooperação do Paciente/psicologia , Estudos Retrospectivos , Escoliose/complicações , Escoliose/diagnóstico por imagem , Curvaturas da Coluna Vertebral/diagnóstico por imagem , Curvaturas da Coluna Vertebral/etiologia , Fusão Vertebral/métodos , Procedimentos Cirúrgicos Torácicos/tendências , Toracoplastia/métodos
7.
Khirurgiia (Mosk) ; (11): 13-19, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31714524

RESUMO

OBJECTIVE: To analyze the results of chest wall reconstruction with titanium mesh implant in patients with total sternal instability following postoperative sternomediastinitis. MATERIAL AND METHODS: There were 100 patients with total sternal instability for the period from January 2016 to December 2018. Median of age was 62 (58; 68) years. Male/female ratio was 82/18. All patients were treated in accordance with standardized protocol. Postoperative complications were assessed using Clavien-Dindo scale. Staged surgical treatment including one or more debridement procedures before the final thoracoplasty was performed in 62 (62%) out of 100 patients. Aseptic sternal instability was observed in 38 patients. RESULTS: Follow-up period ranged from 3 weeks to 35 months after the final thoracoplasty. Complicated postoperative period occurred in 15 (15%) out of 100 patients (95% CI 9.3-23.3). One patient died in 9 days after surgery from acute heart failure. Complications without need for redo surgery, postoperative wound suppuration and seroma were noted in 3 patients. Redo surgery was required in 11 patients due to postoperative wound suppuration, eventration after thoracoomentoplasty, intermuscular hematoma and delayed divergence of major pectoral muscles. Removal of mesh implant was performed in 1 out of 100 patient (95% CI 0.2-5.5) in 7 days after surgery due to suppuration. There was no recurrent sternal instability within 30 days. CONCLUSION: Anterior chest wall reconstruction using titanium mesh implant is an effective and safe procedure in patients with postoperative sternal instability following postoperative sternomediastinitis.


Assuntos
Mediastinite/cirurgia , Osteomielite/cirurgia , Complicações Pós-Operatórias/cirurgia , Esterno/cirurgia , Infecção da Ferida Cirúrgica/cirurgia , Toracoplastia/métodos , Idoso , Feminino , Seguimentos , Humanos , Masculino , Mediastinite/etiologia , Pessoa de Meia-Idade , Osteomielite/etiologia , Implantação de Prótese , Recidiva , Estudos Retrospectivos , Telas Cirúrgicas , Titânio
8.
Kyobu Geka ; 72(10): 845-849, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31582707

RESUMO

Lung cancer invasion of the chest wall is considered to occur in approximately 5% of all patients who had undergone lung cancer resection. Surgical resection is recognized as a standard treatment, and surgical treatment plays a major role because survival is highly dependent on the completeness of the resection. On the other hand, prognosis is still poor in cases with mediastinal lymph node involvement, and the indications for surgery remain controversial in such cases, with increasing number of reported perioperative chemoradiotherapy cases. In addition, the use of minimally invasive surgery combined with thoracoscopy has become widespread in recent years, and indications are being considered for chest wall resection cases. In this paper, we review the results of operation for lung cancer with chest wall invasion other than those for superior sulcus tumors and discuss the role of surgical treatment and surgical resection and reconstruction techniques.


Assuntos
Neoplasias Pulmonares , Parede Torácica , Toracoplastia , Quimiorradioterapia , Humanos , Prognóstico
9.
Medicine (Baltimore) ; 98(36): e17073, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490408

RESUMO

Extremely severe scoliosis patients, especially main thoracic Cobb' s angle >150°, often have severe thoracic deformity and pulmonary dysfunction, even the scoliosis is reduced by halo-pelvic traction, the improvement of pulmonary function is not satisfactory, the risk of spinal osteotomy in the next stage is still very high and left with obvious thoracic deformity. How to further improve the pulmonary function and appearance of these patients is a difficult problem to be solved.Twenty extremely severe scoliosis patients with severe pulmonary dysfunction who underwent concave-side thoracoplasty in our hospital from September 2014 to September 2017 were included, data of thoracic volume and pulmonary function were collected before and after operation. The pulmonary function value reported was predicted forced vital capacity (FVC%), T-test was used to analyze the changes of the data by the statistical software SPSS21.0.The 20 patient's averaged Cobb's angle of main thoracic was 163° ± 8° at admission and all of them with severe pulmonary dysfunction before concave-side thracoplasty. After operation, the thoracic volume of patients increased by 500.9 ±â€Š222.9 mL, FVC% increased by 8.9% ±â€Š7.5%. Both the difference has statistical significance (P < .01).Concave-side thoracoplasty based on the halo-pelvic traction cannot only enlarge the volume of the concave thoracic cavity, lighten the compression of lung and further improve the pulmonary function of extremely severe scoliosis, but also can strengthen the correction of scoliosis and spinal rotation. Therefore, it is a safe and effective surgical approach.


Assuntos
Escoliose/cirurgia , Toracoplastia/métodos , Tração/métodos , Adolescente , Adulto , Feminino , Humanos , Pulmão/fisiopatologia , Masculino , Estudos Retrospectivos , Escoliose/fisiopatologia , Adulto Jovem
10.
Spine Deform ; 7(5): 734-740, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31495473

RESUMO

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To analyze the morbidity of thoracoplasty, and more specifically its effect on pulmonary function, after surgery with hybrid constructs using sublaminar bands in adolescent idiopathic scoliosis (AIS). BACKGROUND: Cosmetic concern is one of the main reasons to consider surgery in adolescent idiopathic scoliosis. Several studies have demonstrated significant improvement of self-image scores after thoracoplasty. However, consequences of thoracoplasty on pulmonary function (ie, pulmonary function tests [PFTs]) remain controversial. METHODS: After institutional review board approval, 96 consecutive AIS patients with thoracic curves (Lenke 1 and 2) were included between January 2014 and November 2015. All patients underwent low-dose stereoradiography with 3D reconstructions. Surgical procedure was the same in all patients: posterior correction using posteromedial translation technique with hybrid constructs (thoracic sublaminar bands and lumbar pedicle screws). Pulmonary function was explored with PFTs (forced vital capacity, forced expiratory volume in 1 second, and total lung capacity). Radiographic parameters and PFT results were compared between patients with and without thoracoplasty preoperatively and at two years postoperation. RESULTS: Mean age was 15 ± 2 years, and body mass index averaged 18.8 ± 2.6. Thirty-six patients (37.5%) underwent thoracoplasty. Both groups were comparable preoperatively regarding demographic data, radiographic parameters, and PFT results. No significant difference was found between groups regarding postoperative correction rates. At the two-year follow-up, PFT results were similar to the preoperative ones and no difference was observed between groups. However, pleural effusions were reported in 26 patients (72%) on chest radiographs. Only one pleural effusion due to thoracoplasty required drainage. CONCLUSION: Results of the current study demonstrated that thoracoplasty associated with posteromedial translation technique did not alter PFT results at two years postoperation. The morbidity of the procedure is limited, and it can therefore be considered in patients with high cosmetic demand and significant residual rib hump after main curve correction. However, hump height and pain evaluation would be interesting data in a prospective study. LEVEL OF EVIDENCE: Level IV.


Assuntos
Escoliose , Toracoplastia , Adolescente , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Derrame Pleural , Complicações Pós-Operatórias , Testes de Função Respiratória , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/epidemiologia , Escoliose/fisiopatologia , Escoliose/cirurgia , Toracoplastia/efeitos adversos , Toracoplastia/métodos , Toracoplastia/estatística & dados numéricos
11.
Artigo em Inglês | MEDLINE | ID: mdl-31347797

RESUMO

The reconstruction of the anterior chest wall after sternectomy for cancer or after mediastinitis is still a challenging procedure for the thoracic surgeon. Different surgical techniques and materials have been used for anterior chest wall reconstruction, but none of them is yet considered to be the gold standard.  In this video tutorial, we report on our experience of using a sternal allograft for reconstruction of the anterior chest wall. Sternal allografts offer the same advantages as bone autografts and obviously are perfectly shaped for sternal replacement. They are simple to trim and to fix to the chest wall and, unlike autografts, do not require the patient to undergo an additional incision and procedure for harvesting the bone.


Assuntos
Neoplasias Ósseas/cirurgia , Condrossarcoma/cirurgia , Esterno/transplante , Doenças Torácicas/cirurgia , Parede Torácica/cirurgia , Toracoplastia/métodos , Aloenxertos , Humanos , Masculino , Pessoa de Meia-Idade
12.
BMC Musculoskelet Disord ; 20(1): 331, 2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31311602

RESUMO

BACKGROUND: Although surgery prevents the progression of deformity and maintains the overall balance of the spine in congenital scoliosis (CS) patients, it is associated with a high risk of perioperative complications. Pulmonary complication is one of the most common complications. This retrospective study aimed to investigate the risk factors for pulmonary complications in CS patients after posterior spinal instrumentation and fusion. METHODS: Analysis of consecutive patients who underwent posterior spinal instrumentation and fusion for congenital scoliosis was performed. Preoperative clinical data, intraoperative variables, and perioperative radiographic parameters were collected to analyze the risk factors for pulmonary complications. Patients were separated into groups with and without postoperative pulmonary complications. Potential risk factors were identified by univariate testing. Multivariate logistic regression was used to evaluate independent predictors of pulmonary complications. RESULTS: Three hundred and twenty-three CS patients were included. Forty-five (13.9%) patients developed postoperative pulmonary complications, which included pleural effusion in 34 (75.6%) cases, pneumonia in 24 (53.3%) cases, pneumothorax in 3 (6.7%) cases, atelectasis in 4 (8.9%) cases, pulmonary edema in 2 (4.4%) cases, respiratory failure in 2 (4.4%) cases, and prolonged mechanical ventilation in 4 (8.9%) cases. The independent risk factors for development of pulmonary complications included age (Odds ratio (OR) = 1.088, P = 0.038), reoperation (OR = 5.150, P = 0.012), preoperative pulmonary disease (OR = 10.504, P = 0.004), correction rate (OR = 1.088, P = 0.001), middle thoracic screw-setting (OR = 12.690, P = 0.043), and thoracoplasty (OR = 5.802, P = 0.001). The area under the receiver operating characteristic (ROC) curve based on predicted probability of the logistic regression was 0.903. CONCLUSIONS: Age, reoperation, preoperative pulmonary disease, correction rate, middle thoracic screw-setting, and thoracoplasty were independent risk factors for pulmonary complications after posterior spinal instrumentation and fusion in CS patients.


Assuntos
Pneumopatias/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Toracoplastia/efeitos adversos , Adolescente , Adulto , Fatores Etários , Parafusos Ósseos/efeitos adversos , Estudos de Casos e Controles , Criança , Feminino , Humanos , Pneumopatias/etiologia , Masculino , Complicações Pós-Operatórias/etiologia , Reoperação/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Escoliose/congênito , Fusão Vertebral/instrumentação , Vértebras Torácicas , Resultado do Tratamento , Adulto Jovem
13.
Zentralbl Chir ; 144(S 01): S31-S42, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31250409

RESUMO

Approximately 10% of patients exhibit a residual pleural space after anatomical lung resection. The most common causes are related to interstitial lung diseases associated with reduced compliance and air leaks. If no complication occurs by the end of the 4th week, an uncomplicated course (absorption of air) can be expected. In the event of pleural space infection and/or bronchopleural fistula, there is a risk of aspiration, with the development of life-threatening pneumonia. In such cases, surgical treatment is indicated. The choice of surgical procedure is an individual decision, whereby the general condition, coexisting diseases, patient's mobility and motivation, pulmonary function, the lung tissue quality, the underlying disease with its prognosis and local as well as systemic effects of the pleural space infection must be taken into account. For the surgical therapy of the residual pleural space, the following methods are available: pleural drainage, pneumoperitoneum, pleura tent, lung decortication, space filling muscle transposition, thoracoplasty, thoracostomy, or combined procedures. Pleural drainage and decortication require an expandable lung. Postpneumonectomy empyema poses a particular challenge. To avoid a pleural space in cases of high risk conditions, prophylactic measures (pleural tent, pneumoperitoneum, N. phrenicus blockage) can already be performed during initial intervention.


Assuntos
Fístula Brônquica , Doenças Pleurais , Toracoplastia , Empiema Pleural , Humanos , Pneumonectomia , Toracostomia
14.
J Plast Reconstr Aesthet Surg ; 72(11): 1776-1784, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31201108

RESUMO

OBJECTIVES: There is limited information of the health-related quality of life (HRQoL) after surgical treatment of chest wall tumors. This cross-sectional study aimed to assess long-term HRQoL after chest wall reconstruction following oncological resection. METHODS: Seventy-eight patients having undergone chest wall tumor resection and reconstruction during 1997-2015 were invited to complete the 15D and QLQ-C30 HRQoL instruments. RESULTS: Altogether, 55 patients (17 men and 38 women), with a mean (SD) age of 68 (14) years, completed the questionnaires (response rate 71%). Patients had been operated due to soft tissue sarcoma (n = 16), advanced breast cancer (n = 15), osteo- or chondrosarcoma (n = 14), or other tumor (n = 10). Median time after primary surgery was 66 (IQR 38, 141) months. The resection was full thickness in 29/55 cases and partial thickness in 26/55 cases. Chest wall reconstruction was required for 47/55 cases (85%). Reconstruction was performed using soft-tissue flap in eight cases, skeletal stabilizations with mesh or mesh-cement-mesh (sandwich method) in 15 cases, and skeletal stabilizations and soft-tissue flap in 24 cases. Patients' mean 15D score (0.878, SD 0.111) was comparable to that of the age- and gender-standardized general population (0.891, SD 0.041). Limitations in breathing and usual activities were noted. The QLQ-C30 cancer-specific HRQoL was 72 points (maximum 100). Scores in the QLQ-C30 Functional scales ranged from 78 (Physical) to 91 (Social). CONCLUSIONS: Long-term HRQoL in patients after chest wall reconstruction following oncological resection is fair and comparable to that of the general population. Limitations in breathing and usual activities can occur.


Assuntos
Qualidade de Vida , Neoplasias Torácicas/cirurgia , Parede Torácica , Toracoplastia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Neoplasias Torácicas/patologia , Fatores de Tempo , Resultado do Tratamento
15.
Interact Cardiovasc Thorac Surg ; 29(4): 497-502, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31199434

RESUMO

The aim of the review was to evaluate the routine use of sternal elevation techniques (SETs) during minimally invasive repair of pectus excavatum (MIRPE, the Nuss procedure). We performed a review of the literature between January 1998 and September 2018 with focus on different methods of SET during MIRPE. Reported effects and side effects were evaluated and compared with our own experience concerning the routine use of the vacuum bell for sternal elevation during MIRPE during the last 13 years. SET is more often used in adult patients than in adolescents. SET improves visualization and safety of MIRPE. Advancement of the pectus introducer, retrosternal dissection and placement of the pectus bar are easier. The risk of cardial and/or pericardial lesion is reduced significantly. Different types of retractors, a crane combined with a wire and/or customized hooks are reported to be used as SET. Furthermore, routine use of a subxiphoid incision is reported. However, more technical equipment, and in some SETs additional incisions are necessary. In contrast, no additional skin incision is necessary for the vacuum bell. The routine intraoperative use of the vacuum bell was safe and effective in 131 patients. It facilitates the retrosternal dissection and the insertion of the pectus bar like other SETs. Besides a temporary mild hematoma, no relevant side effect was observed. In conclusion, an increasing number of authors report on the routine use of SET during MIRPE to improve safety of the procedure. We recommend the routine intraoperative use of the vacuum bell during MIRPE.


Assuntos
Tórax em Funil/cirurgia , Esterno/cirurgia , Toracoplastia/métodos , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Vácuo
16.
J Pediatr Surg ; 54(10): 1976-1983, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30922685

RESUMO

PURPOSE: The purpose of this study was to determine outcomes of an enhanced recovery pathway (ERP) for minimally invasive repair of pectus excavatum (MIRPE) at a high volume center, hypothesizing it is associated with decreased opioid requirement and shorter hospital stay. METHODS: Patients were categorized into pre-ERP (1998-2006), transition (2007-2011), and ERP (2012-2017) cohorts. Data were abstracted from medical records. Univariate and multivariable analyses compared opioid utilization, length of stay (LOS), and complications between cohorts. Opioids were converted to morphine daily dose per kilogram (MEDD/kg). RESULTS: Of 436 patients, 186 were ERP, 104 were transition, and 146 were pre-ERP. ERP was associated with decreased hospital opioid utilization (mean MEDD/kg 0.5 ±â€¯0.2 vs 0.7 ±â€¯0.4 vs 0.7 ±â€¯0.8 p < .001) and shorter median LOS (3 vs 4 vs 5 days, p < .001) despite equivalent pain scores at discharge (2.7 ±â€¯0.1 vs 2.8 ±â€¯0.2 vs 2.9 ±â€¯0.3, p = .73). Most ERP patients (76%) had LOS ≤3 days. Differences in LOS between ERP, transition, and pre-ERP persisted on multivariable analysis after adjusting for confounding factors. Post-operative complications were rare and not different between groups (p > .05). CONCLUSIONS: Implementation of our ERP was associated with decreased opioid requirement and shorter hospital stay. ERPs are a valuable tool in pediatric surgery given the current emphasis on optimizing opioid and resource utilization. LEVELS OF EVIDENCE: Level III (Retrospective comparative study).


Assuntos
Analgésicos Opioides/uso terapêutico , Tórax em Funil/cirurgia , Laparoscopia/métodos , Tempo de Internação/tendências , Dor Pós-Operatória/tratamento farmacológico , Recuperação de Função Fisiológica/efeitos dos fármacos , Toracoplastia/métodos , Adolescente , Adulto , Criança , Feminino , Humanos , Incidência , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Dor Pós-Operatória/epidemiologia , Alta do Paciente/tendências , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
17.
Gen Thorac Cardiovasc Surg ; 67(11): 996-998, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30790238

RESUMO

Desmoid-type fibromatosis is a rare soft tissue tumor and the chest wall is one of the common sites of its extra-abdominal occurrence. A bifid rib is one of the congenital rib abnormalities. We report a case of desmoid-type fibromatosis arising in a chest wall's bifid rib. A 42-year-old female complained of right chest pain without remarkable medical, traumatic, or familial history. Chest-computed tomography revealed a chest wall tumor located adjacent to a bifid costal cartilage of third rib. We performed chest wall resection of second and third ribs. Pathologically, the tumor was diagnosed a desmoid-type fibromatosis of the chest wall. We surmise mechanical stimulation due to the bifid rib may be related to the occurrence of the tumor. In case of desmoid-type fibromatosis without somatic gene mutation, traumatic history, wound, implants, or use of female hormonal agents, we should search also local congenital abnormality.


Assuntos
Fibroma/cirurgia , Costelas/anormalidades , Neoplasias Torácicas/cirurgia , Adulto , Cartilagem Costal , Feminino , Fibroma/etiologia , Fibroma/patologia , Humanos , Anormalidades Musculoesqueléticas/complicações , Neoplasias Torácicas/etiologia , Neoplasias Torácicas/patologia , Parede Torácica , Toracoplastia , Tomografia Computadorizada por Raios X
18.
Interact Cardiovasc Thorac Surg ; 28(5): 783-788, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30541025

RESUMO

OBJECTIVES: The aim of this study is to describe an effective surgical strategy for the treatment of children with pectus excavatum (PE) and concurrent congenital heart defect (CHD). METHODS: We retrospectively reviewed the medical records of all children (n = 16) who underwent simultaneous repair of PE with concurrent CHD at the Hunan Children's Hospital from July 2007 to December 2017. Among them, 7 patients had a simple atrial septal defect (ASD); 4 patients had a simple ventricular septal defect (VSD); 3 patients had both VSD and ASD; 1 patient had VSD, ASD and patent ductus arteriosus; and 1 patient had VSD complicated by pulmonary hypertension. To repair PE, we performed one of the 3 procedures: an open sternal elevation involving freeing the tissue from the posterior sternum and lifting the sternum by wires, a Nuss repair or a repair with a custom-made sternal lifting device. The CHDs were repaired using one of the 3 methods as well: open heart surgery using cardiopulmonary bypass, transcatheter closure under echocardiography or X-ray-guided percutaneous intervention. RESULTS: In all 16 patients, the operations led to satisfactory repair of both conditions without serious complications. All parents and children were satisfied with the postoperative appearance of the chests. CONCLUSIONS: By choosing the correct operative approach based on patient characteristics, simultaneous elective repair of PE and concurrent CHD is safe and effective, avoids the risk of multiple staged operations and achieves satisfactory outcomes.


Assuntos
Anormalidades Múltiplas , Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Tórax em Funil/cirurgia , Cardiopatias Congênitas/cirurgia , Toracoplastia/métodos , Criança , Pré-Escolar , Ecocardiografia , Feminino , Tórax em Funil/diagnóstico , Cardiopatias Congênitas/diagnóstico , Humanos , Masculino , Período Pós-Operatório , Radiografia Torácica , Estudos Retrospectivos
19.
Clin Imaging ; 53: 138-142, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30340077

RESUMO

PURPOSE: Preoperative assessment of patients with pectus excavatum (PE) demands evaluation of malformation indexes, generally with chest computed tomography (CT). In addition, assessment of the cardiac impact of sternal depression has become a rule in high referral centers, thus requiring two independent imaging modalities and use ionizing radiation in a very young population. The objective of this study was to explore the agreement between chest CT and standard cardiac MR (CMR) for the evaluation of chest wall malformation indexes. METHODS: We included consecutive patients with PE referred to undergo chest CT and CMR to establish surgical candidacy and/or to define treatment strategies. Both CT and CMR were performed at full-expiration. In both modalities, the Haller index (HI) and the Correction index (CI) were calculated by two independent observers. In CMR, only scout images were used. Agreement was evaluated using intra-class correlation coefficients (ICC). RESULTS: Fifty patients comprised the study population (median age 19.0 years) and underwent chest CT and CMR within the same month. CMR assessment of chest malformation indexes was reproducible, with a very good inter-observer agreement for HI [ICC 0.93 (0.88-0.96), p < 0.0001] and CI [ICC 0.91 (0.83-0.95), p < 0.0001]. CMR also had a very good agreement with chest CT for HI [ICC 0.90 (0.82-0.94), p < 0.0001] and CI measurements [ICC 0.93 (95% CI 0.88-0.96), p < 0.0001]. CONCLUSIONS: We demonstrated an excellent agreement between chest CT and standard CMR for the assessment of chest wall malformations, thus potentially enabling preoperative assessment of PE severity and cardiac involvement with a single diagnostic tool.


Assuntos
Tórax em Funil/diagnóstico , Imagem Cinética por Ressonância Magnética/métodos , Parede Torácica/diagnóstico por imagem , Toracoplastia , Adulto , Feminino , Tórax em Funil/cirurgia , Humanos , Masculino , Período Pré-Operatório , Reprodutibilidade dos Testes , Estudos Retrospectivos , Parede Torácica/anormalidades , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
20.
Thorac Surg Clin ; 29(1): 47-58, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30454921

RESUMO

Multidrug-resistant tuberculosis (TB), extensively drug-resistant TB, and TB-human immunodeficiency virus (HIV) coinfection require a special approach in anti-TB treatment. Most patients cannot be successfully cured by conventional chemotherapy alone. They need a modern approach using minimally invasive therapeutic and surgical techniques. The novel approaches of collapse therapy techniques and minimally invasive osteoplastic thoracoplasty increase the effectiveness of complex anti-TB therapy. Achieving the required selective collapse of lung tissue in destructive pulmonary TB, especially in cases of drug resistance and/or HIV coinfection, leads to bacteriologic conversion, cavity closure, and successful cure.


Assuntos
Colapsoterapia/métodos , Toracoplastia/métodos , Tuberculose Pulmonar/cirurgia , Adulto , Antituberculosos/uso terapêutico , Tuberculose Extensivamente Resistente a Medicamentos/cirurgia , Tuberculose Extensivamente Resistente a Medicamentos/terapia , Feminino , Humanos , Pulmão/cirurgia , Masculino , Tuberculose Resistente a Múltiplos Medicamentos/cirurgia , Tuberculose Resistente a Múltiplos Medicamentos/terapia , Tuberculose Pulmonar/terapia
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