Reconstrução da parede torácica após a ressecção de extensos tumores / Reconstruction of chest wall after resection of large tumors

INTRODUÇÃO: Nos estágios finais da reconstrução torácica, consequente a exéreses tumorais, são necessários procedimentos complexos e implantes. O que requer cuidados multidisciplinares, com a participação dos cirurgiões torácicos, plástico, radiologista e fisioterapeuta. O objetivo foi descrever as opções de reconstrução torácica após ressecção de neoplasia, realizado no Hospital Sarah Brasília. MÉTODO: Estudo retrospectivo de reconstrução torácica em tempo único, após excisão de tumor, fisioterapia respiratória com ventilação não invasiva e exercícios. RESULTADOS: Entre 2007 a 2012 foram operados 10 pacientes, sete homens e três mulheres; idade 10 a 31 anos; oito apresentavam tumores torácicos metastáticos (osteosarcoma, sinoviosarcoma, Fibrosarcoma epitelioide esclerosante e Rabdomiosarcoma) e dois originários da parede torácica (fibromatose e condrosarcoma). Observou-se boa evolução no pós-operatório imediato, com extubação ao final da cirurgia, retirada do dreno torácico entre 5° e 8° PO. As complicações foram: atelectasia (10%), recorrência tumoral (10%), e óbito em 3 (30%) casos . CONCLUSÃO: Foi possível a reconstrução torácica em tempo único utilizando tela de polipropileno, polimetilmetacrilato e retalhos musculares, com recuperação precoce da função pulmonar e baixo índice de complicações imediatas.

INTRODUCTION: Complex procedures and implants are required in the final stages of chest wall reconstruction after tumor excision. This process requires multidisciplinary care with participation from thoracic and plastic surgeons, a radiologist, and a physical therapist. The goal of this study was to describe the options for chest wall reconstruction after neoplasm resection at Hospital Sarah Brasilia. METHOD: A retrospective study of one-time chest wall reconstruction after tumor excision, respiratory physical therapy with noninvasive ventilation, and exercises was conducted. RESULTS: Between 2007 and 2012, 10 patients underwent surgery (seven men, three women; age range: 10-31 years); eight patients had metastatic thoracic tumors (e.g., osteosarcoma, synovial sarcoma, sclerosing epithelioid fibrosarcoma, and rhabdomyosarcoma) and two had tumors originating from the chest wall (fibromatosis and chondrosarcoma). The outcomes were good after the immediate postoperative period, with extubation occurring at the end of surgery and chest tube removal between the fifth and eighth postoperative day. Three cases (30%) involved complications of atelectasis (10%), tumor recurrence (10%), or death. CONCLUSION: One-time chest wall reconstruction using polypropylene mesh, polymethylmethacrylate, and muscle flaps was possible and was associated with early recovery of pulmonary function and a low rate of immediate complications.

Reconstrucción de defectos torácicos complejos / Reconstruction of complex chest wall defects

Los grandes defectos torácicos requieren generalmente procedimientos complejos para su reparación; en la mayoría de los casos es necesaria la combinación de tejidos autólogos y materiales aloplásticos, por lo que constituye un desafío para el cirujano plástico. En nuestra institución los que se presentan suelen ser secundarios a exéresis tumoral, bien de origen primario o secundario. Se dispone de varias opciones reconstructivas para cubrir los amplios defectos resultantes de las amplias escisiones y poder aportar colgajos vascularizados, amplios y voluminosos. A pesar de no disponer en nuestro medio de técnicas avanzadas para el soporte rígido, hemos podido dar cobertura a todos los defectos y se ha garantizado una adecuada estabilidad de la pared torácica. Presentamos cuatro casos tratados por grandes defectos del tórax. Se tuvo como objetivo mostrar la forma en que se realizó la reconstrucción inmediata con la combinación de colgajos miocutáneos y material aloplástico(AU)

Reconstruction of large defects of the chest wall frequently requires the use of complex techniques that combines autologous tissues and alloplastic materials, which poses a real challenge for the cosmetic surgeon. Those chest defects that are seen in our institution are secondary to tumor excision, either of primary or of secondary origin. Many reconstructive options are necessary to cover large defects as a result of wide resection of tumors and to supply the defect with large, bulky and well vascularized flaps. Although advanced techniques for rigid support are not available in our conditions, it has been possible to cover all defects and to assure adequate stability of the chest wall. Four cases of large chest defects were presented in this paper. The objective was to show how the immediate reconstruction was carried out by combining autologous flaps and alloplastic materials(AU)