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1.
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
2.
Thorac Surg Clin ; 28(3): 323-335, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30054070

RESUMO

Development of postpneumonectomy empyema with bronchopleural fistula is a life-threatening condition that requires prompt action. Although measures should be taken to prevent bronchopleural fistula at time of pneumonectomy, many patients experience this complication. Management focuses on drainage of the pleural space, control of the pleural infection including repair of the bronchopleural fistula, and obliteration of the residual pleural cavity. Multiple techniques and procedures have been developed over time to achieve these goals. Knowledge of the diverse therapeutic options is important to select the optimal treatment for these complex patients.


Assuntos
Brônquios/cirurgia , Fístula Brônquica/cirurgia , Empiema Pleural/terapia , Doenças Pleurais/cirurgia , Pneumonectomia/efeitos adversos , Esterno/cirurgia , Toracoplastia , Fístula Brônquica/etiologia , Fístula Brônquica/prevenção & controle , Fístula Brônquica/terapia , Empiema Pleural/etiologia , Empiema Pleural/prevenção & controle , Empiema Pleural/cirurgia , Humanos , Doenças Pleurais/etiologia , Doenças Pleurais/prevenção & controle , Doenças Pleurais/terapia , Procedimentos Cirúrgicos Torácicos/métodos , Toracoplastia/efeitos adversos
3.
Khirurgiia (Mosk) ; (5): 81-85, 2018.
Artigo em Russo | MEDLINE | ID: mdl-29798996

RESUMO

AIM: To improve the results of surgical treatment of pectus carinatum. MATERIAL AND METHODS: The work included 47 pectus carinatum patients aged 3-15 years for the period from 2000 to 2015. All patients were divided into 2 groups depending on surgical approach: control group - 23 (48.94%) children who underwent thoracoplasty by M.M. Ravitsh procedure with the use of device for pectus carinatum repair of our design; main group - 24 (51.06%) patients where our method of thoracoplasty based on changes of deformed ribs biomechanics was used. RESULTS: In control group good results were obtained in 15 (65.3%) patients, satisfactory - in 5 (21.7%) patients, recurrent deformation with all consequences was observed in 3 (13%) cases. Long-term results of surgical treatment by original method were followed-up in all 24 patients and good outcomes were obtained in 100% of children. CONCLUSION: 1) Intraoperative 'spring' - effect is a provoking risk factor of recurrent chest deformation. 2) The new surgical method based on breaking the ribs bodies in 'green branch' fashion provides good results and does not require external devices to hold sternal-rib complex in corrected position.


Assuntos
Pectus Carinatum/cirurgia , Costelas , Esterno/cirurgia , Toracoplastia , Adolescente , Fenômenos Biomecânicos , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pectus Carinatum/diagnóstico , Pectus Carinatum/fisiopatologia , Prognóstico , Recidiva , Reoperação , Costelas/patologia , Costelas/fisiopatologia , Costelas/cirurgia , Fatores de Risco , Esterno/anormalidades , Esterno/fisiopatologia , Toracoplastia/efeitos adversos , Toracoplastia/métodos , Resultado do Tratamento
4.
Khirurgiia (Mosk) ; (3. Vyp. 2): 39-42, 2018.
Artigo em Russo | MEDLINE | ID: mdl-29652321

RESUMO

AIM: To evaluate the effect of various methods of thoracoplasty on local production of cytokines in patients with pulmonary tuberculosis. MATERIAL AND METHODS: The main group consisted of patients after traditional thoracoplasty. Thoracoplasty was compared with endoprosthesis of polypropylene mesh 'Surgipro - SPMM-149'. TNF-α and IL-10 cytokines in exudate from surgical area were measured by using of solid-phase enzyme immunoassay (OOO 'Vector-Best', Russia). RESULTS: It was revealed that local production of pro- and anti-inflammatory cytokines is more pronounced after thoracoplasty with polypropylene mesh 'Surgipro - SPMM-149'. Local cytokine balance changes towards inflammation were more pronounced after thoracoplasty with mesh implant and did not depend on the degree of drug sensitivity.


Assuntos
Exsudatos e Transudatos/química , Interleucina-10/análise , Telas Cirúrgicas/efeitos adversos , Toracoplastia/efeitos adversos , Tuberculose Pulmonar/cirurgia , Fator de Necrose Tumoral alfa/análise , Materiais Biocompatíveis , Citocinas/análise , Humanos , Inflamação/imunologia , Polipropilenos , Toracoplastia/métodos
5.
Ann Thorac Surg ; 105(2): 371-378, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29198628

RESUMO

BACKGROUND: Minimally invasive repair of pectus excavatum (MIRPE) has been extended to repair of defects in adults, with reported higher complication rates and outcome failures. The optimal revision for a prior failed MIRPE in an adult has not been identified. We review our experience for this adult population. METHODS: A retrospective review was performed of 129 patients (age ≥18 years) who underwent revision after a failed pectus excavatum (PE) repair from December 2010 through December 2016. RESULTS: In total, 47 of the 129 (36%) revision patients had a prior failed MIRPE, with 98% presenting for revision because of inadequate correction after their initial repair. The median age was 28 years (range, 18 to 54 years), and 77% were men. Thirty-one (66%) patients had indwelling pectus support bars at the revision procedure. Mean time from initial MIRPE to the revision procedure was 3.34 ± 2.9 years. A modified MIRPE was successful in 39 (83%) patients. Hybrid repair with the addition of osteotomy cuts and/or titanium plating was required in 8 patients for an adequate revision. Multiple (2 bars, 62%; 3 bars, 38%), shorter (median, 13.5 inches versus 15.0 inches) bars were used for the revision versus earlier repair. Substantial lysis of intrathoracic adhesions was required in 40 (85%) patients, with a median operative time for revision MIRPE of 169 ± 66 minutes; median operative time for hybrid procedures, 314 ± 74 minutes. CONCLUSIONS: A modified MIRPE can be successfully used in most adults to revise a failed prior MIRPE.


Assuntos
Tórax em Funil/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Osteotomia/métodos , Parede Torácica/cirurgia , Toracoplastia/efeitos adversos , Adolescente , Adulto , Criança , Feminino , Tórax em Funil/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Radiografia Torácica , Reoperação , Estudos Retrospectivos , Parede Torácica/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Falha de Tratamento , Adulto Jovem
6.
Pril (Makedon Akad Nauk Umet Odd Med Nauki) ; 38(2): 99-105, 2017 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-28991771

RESUMO

Pleural infection is a frequent clinical condition. Prompt treatment has been shown to reduce morbidity, mortality and duration of hospital stay. Unfortunately, advanced stages of empyema need to use extensive surgery - decortications or thoracoplasty. Early recognition of the parapneumonic effusion and the adequate treatment with thoracentesis or pleural drainage, which is minimally invasive, is possible not to prograde the process and not to become empyema. AIM: To analyze the results of the surgical treatment in patients with empyema treated at Clinic for thoracic surgery. MATERIAL AND METHODS: In the retrospective study we analyzed 234 patients with empyema which were treated at the Clinic for Thoracic Surgery in 5 year period (2011-2015). The mean age of the patients was 51.94 years. They were treated with pleural drainage, decortications or thoracoplasty. RESULTS: With pleural drainage were treated 165/234 (70.51%) patients, of which successfully were finished 124/165 (75.15%), but 41/165 (24.85%) were indicated after the decortications. A total of 108/234 (46.15%) were treated with decortications from which, primary decortications were indicated in 67/234 (28.63%) patients. 5/234 (2.14%) patients were treated with thoracoplasty - 3 of the patients with decortications and 2 with primary indicated thoracoplasty according to the local findings, long term untreated empyema and bad general condition. The Mean hospitalization was 17.4 days, of which 13.4 days after surgery. In the group with primary drainage it was detected a lethal outcome in 7/124 (5.64%) patients, 5/105 (4.76%) in the group with decortications and 2/5 (40%) in the group with thoracoplasty. CONCLUSION: Early detection of the parapneumonic effusion and the adequate treatment will prevent the appearance of empyema. If the empyema is detected it is necessary as early as possible to start the treatment with minimally invasive pleural drainage. In earlier stages it is possible to use less invasive decortications, using VATS than the open thoracotomy decortication which is more extensive surgical intervention.


Assuntos
Drenagem/métodos , Empiema Pleural/cirurgia , Toracoplastia/métodos , Drenagem/efeitos adversos , Drenagem/mortalidade , Empiema Pleural/diagnóstico por imagem , Empiema Pleural/mortalidade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Toracoplastia/efeitos adversos , Toracoplastia/mortalidade , Fatores de Tempo , Resultado do Tratamento
7.
Khirurgiia (Mosk) ; (7): 24-29, 2017.
Artigo em Russo | MEDLINE | ID: mdl-28745702

RESUMO

AIM: To perform the prospective non-randomized single-center trial of pectus excavatum correction in adults. MATERIAL AND METHODS: For the period March 2012 - March 2016 64 patients aged 18-44 years were treated. Median age was 23 years. Male/female ratio was 41/23. All patients were included into standard survey protocol: chest MDCT, MRI of thoracic spine, pulmonary function test, echocardiography. Quality of life and complications rate after the Nuss procedure (n=50, 78.1%, group 1) and radical thoracoplasty using nikelid-titanium bar (n=14, group 2) were evaluated. RESULTS: There was earlier recovery in the 1st group: 3 (2; 4) and 6 (5; 7) days after minimally invasive and radical thoracoplasty, respectively. Postoperative Dindo-Clavien I-IIIa complications developed in 46 (71.8%) patients. Most of them did not require additional procedures. CONCLUSION: Nuss procedure is safe method and can be performed with good results in adults.


Assuntos
Tórax em Funil , Complicações Pós-Operatórias , Qualidade de Vida , Toracoplastia , Adulto , Ecocardiografia/métodos , Feminino , Tórax em Funil/diagnóstico , Tórax em Funil/fisiopatologia , Tórax em Funil/psicologia , Tórax em Funil/cirurgia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Testes de Função Respiratória/métodos , Federação Russa , Toracoplastia/efeitos adversos , Toracoplastia/métodos , Tomografia Computadorizada por Raios X/métodos
8.
J Cardiothorac Surg ; 12(1): 61, 2017 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-28738822

RESUMO

BACKGROUND: Cardiac arrest is a lethal complication of Nuss repair of pectus excavatum which is strongly related to heart or big vessels injury. A rare case developed cardiac arrest without direct cardiac injury during Nuss procedure is presented in this article. CASE PRESENTATION: In July 2015, a previously healthy 18-year-old man undergoing Nuss repair for pectus excavatum developed cardiac arrest while the Nuss bar was being inserted into the chest. After successful resuscitation and exclusion of direct cardiac injury, the Nuss procedure was continued. The patient suffered a second cardiac arrest during rotation of the Nuss bar. This time, the patient had poor initial response to resuscitation and defibrillation until the retrosternal bar was removed. He ultimately recovered well from the episodes of cardiac arrest, but was unable to receive surgical correction of his pectus excavatum deformity. CONCLUSIONS: The possible mechanisms of cardiac arrest and lessons we can learn from this complication are discussed.


Assuntos
Tórax em Funil/cirurgia , Parada Cardíaca/etiologia , Complicações Intraoperatórias , Toracoplastia/efeitos adversos , Adolescente , Cardioversão Elétrica , Parada Cardíaca/terapia , Traumatismos Cardíacos , Humanos , Masculino , Ressuscitação/métodos , Lesões do Sistema Vascular/complicações
9.
Eur J Cardiothorac Surg ; 52(1): 76-82, 2017 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-28329150

RESUMO

OBJECTIVES: Scoliosis is associated with pectus excavatum. However, the change in the degree of scoliosis after pectus excavatum correction has not been clarified. This study examined how the correction of pectus excavatum influences the status of pre-existing scoliosis. METHODS: A total of 779 pectus excavatum patients operated between 2007 and 2011 using the pectus bar were retrospectively analysed. Preoperative severity and postoperative change of scoliosis in accordance with the severity of pectus excavatum were evaluated. Cobb angle, Haller index and sternal tilt degree were measured from pre- and postoperative whole-spine anteroposterior radiographs and chest computed tomography. RESULTS: Sixty-three (8%) patients had scoliosis (Cobb angle >10°). No significant correlation was noted between postoperative changes in Cobb angle, Haller index or sternal tilt angle. Preoperative severity of scoliosis showed a positive correlation with postoperative changes in Cobb angle ( r = 0.527, P < 0.001). In analyses between groups with mild and moderate scoliosis (Cobb angle <15° and >15°, respectively), the mean postoperative Cobb angle was decreased in mild scoliosis (-2.88°) but was increased in moderate scoliosis (3.86°; P < 0.001). Regarding the 'improvement' and 'aggravation' of scoliosis after pectus correction, preoperative severity of scoliosis was the only significant factor in univariable and multivariable analysis. CONCLUSIONS: Pectus excavatum repair using a pectus bar may improve scoliosis, but when the preoperative Cobb angle exceeds 15°, scoliosis may be aggravated. Therefore, pectus excavatum with concomitant moderate scoliosis requires extra caution during repair. This preliminary result suggests further investigation into the effect of chest cage remodelling on spine dynamics.


Assuntos
Tórax em Funil/cirurgia , Complicações Pós-Operatórias/epidemiologia , Escoliose/epidemiologia , Toracoplastia/efeitos adversos , Feminino , Humanos , Incidência , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Prognóstico , Radiografia Torácica , República da Coreia/epidemiologia , Estudos Retrospectivos , Escoliose/diagnóstico , Escoliose/etiologia , Vértebras Torácicas , Toracoplastia/métodos , Tomografia Computadorizada por Raios X , Adulto Jovem
10.
J Pediatr Surg ; 52(8): 1292-1295, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28087135

RESUMO

BACKGROUND: Pectus excavatum repair (PEX) is among the most painful thoracic procedures performed. Continuous peripheral nerve blockade (CPNB) is known to be efficacious in optimizing pain control while limiting narcotic use in adult thoracic procedures. It was introduced in May 2015 as a bridge to oral pain control in children undergoing PEX. Consequently, the surgical site infection (SSI) rate increased from 2.7% to 27.7%. METHODS: SSI surveillance followed national guidelines. The abrupt increase prompted root cause analysis and cessation of CPNB use. A dynamic systems model of SSI in PEX was developed. Statistical analysis compared SSI outcomes with and without CPNB. RESULTS: From May 2015 to June 2015, 21 PEX were performed; 11 with CPNB. 6 SSIs were observed. Use of CPNB significantly (p=0.008) increased SSI incidence. Haller index, number of bars, usage of Fiberwire®, methicillin resistant S. aureus colonization and length of stay did not differ. Root cause analysis revealed the proximity of CPNB catheters to the wound, the use of CPNB with implanted hardware and a delayed utilization of CPNB catheters to be of concern. CONCLUSION: Introduction of CPNB coincided with a significant increase in SSI. Further study is needed to assess the safety of CPNB in pediatric PEX. LEVEL OF EVIDENCE: Level III treatment study.


Assuntos
Tórax em Funil/cirurgia , Polímeros/farmacologia , Análise de Causa Fundamental/métodos , Infecções Estafilocócicas/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Toracoplastia/efeitos adversos , Adolescente , Criança , Elastômeros , Feminino , Humanos , Incidência , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Estudos Retrospectivos , Infecções Estafilocócicas/microbiologia , Infecção da Ferida Cirúrgica/microbiologia , Toracoplastia/métodos , Estados Unidos/epidemiologia
12.
Rev Pneumol Clin ; 72(6): 333-339, 2016 Dec.
Artigo em Francês | MEDLINE | ID: mdl-27776948

RESUMO

INTRODUCTION: The occurrence of empyema after pneumonectomy or in suites with chronic pleural pocket is a dreaded complication. The management is long and difficult. The authors report their experience before this complication including infection control by an emptying of the pleural pocket percutaneous drainage or thoracostomy which will be complemented by a thoracomyoplasty the aim to erase the pleural pocket. MATERIALS AND METHODS: This is a retrospective study conducted between 2009 and 2015 concerning the records of 9 patients treated for empyema or in the aftermath of a lung resection or as part of a chronic pleural pocket and calcific. RESULTS: We had identified all 9 male patients aged 30 to 67 years. This was pyothorax complicating pneumonectomy in 4 patients and 1 pyothorax after a left upper lobectomy in 1 case. For the other 4 patients, there was a post-tuberculous pleural pocket, calcified chronic and whose attempts to decortication seemed impossible. We observed 3 cases of bronchopleural fistula. All patients had received evacuation of the contents of the pleural drainage bag is either thoracostomy laying the bed of a possible filling thoracomyoplasty. The evolution of pleural cavities after thoracostomy was favorable on septic map leading to a retraction of the pleural cavity and its spontaneous closure in 1 patient. In 6 patients, filling the cavity with thoracomyoplasty was necessary. The evolution immediate postoperative was favorable in all patients and no deaths were noted in connection with this technique. CONCLUSION: Pyothorax on pneumonectomy cavity and chronic pleural calcified pockets are serious complications whose management is long and delicate. The thoracomyoplastie is a real alternative to the filling of the cavity in fragile patients with significant operational risk. The results are satisfactory in the hands of a broken team this technique.


Assuntos
Empiema Pleural/cirurgia , Toracoplastia/estatística & dados numéricos , Toracostomia/estatística & dados numéricos , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Toracoplastia/efeitos adversos , Toracoplastia/métodos , Toracostomia/efeitos adversos , Toracostomia/métodos , Toracotomia/efeitos adversos , Toracotomia/métodos , Toracotomia/estatística & dados numéricos
13.
Plast Reconstr Surg ; 138(2): 317e-29e, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27465193

RESUMO

BACKGROUND: Various methods of corrective thoracoplasty for pectus carinatum deformity have been described, but to date no studies describe a review of complications and how to manage them. Complications are dependent not only on the technique used and the patient's age, but also on the experience of the treating surgeon. The authors present their 15 years' experience with surgical correction of pectus carinatum and the complications that have occurred. A literature review regarding complications with pectus carinatum surgery is performed. METHODS: A retrospective review of 95 patients (mean age, 19 years) was performed. One hundred four surgical procedures for repair of pectus carinatum were performed from July of 2000 to July of 2015 using a modified Ravitch technique, bioabsorbable material, postoperative bracing, and in some cases a diced rib cartilage graft technique. Intraoperative and postoperative complications were evaluated. RESULTS: The mean patient follow-up was 13.6 months (range, 4 months to 9.75 years). Intraoperative complications were pleura lesion and laceration of the internal mammary vein. Postoperative complications were recurrent mild protrusion, persistent protrusion of one or two costal cartilages, minor wound healing delay, skin ulcer, hypertrophic scar, transient intercostal dysesthesia, marginal pneumothorax, seroma, meningitis, and epidural hematoma. CONCLUSIONS: In our reported series of pectus carinatum repair, increasing experience and progressively less extensive techniques have resulted in fewer complications, low morbidity, and early return to activity. Complications were observed in the early period of application, predominantly because of a lack of experience, and usually subsided with increasing numbers of patients and frequency of surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Previsões , Pectus Carinatum/cirurgia , Complicações Pós-Operatórias , Toracoplastia/efeitos adversos , Humanos
14.
Eur Spine J ; 23 Suppl 4: S424-31, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24823848

RESUMO

INTRODUCTION: Untreated growing patients with congenital scoliosis and fused ribs will develop finally thoracic insufficiency syndrome. The technique of expansion thoracoplasty with implantation of a vertical expandable prosthetic titanium rib (VEPTR) was introduced initially to treat these children. METHODS: This article attempts to provide an overview of the surgical technique of opening-wedge thoracostomy and VEPTR instrumentation in children with congenital thoracic scoliosis and fused ribs. RESULTS: Our modification of the surgical approach using a posterior midline incision rather than the modified thoracotomy incision initially described could potentially help to diminish wound dehiscence and secondary infection, while preserving a more acceptable esthetic appearance of the back. CONCLUSIONS: Vertical expandable prosthetic titanium rib-based treatments should be undertaken only with a good knowledge of its numerous specific complications. Every aspect of the treatment should be oriented to minimize these complications. At the same time it should be kept in mind that the ultimate step of this long-term fusionless treatment strategy will be a technically demanding spine fusion.


Assuntos
Próteses e Implantes , Costelas/cirurgia , Escoliose/cirurgia , Vértebras Torácicas/cirurgia , Toracoplastia/métodos , Toracostomia/métodos , Criança , Feminino , Humanos , Lactente , Anormalidades Musculoesqueléticas/diagnóstico por imagem , Anormalidades Musculoesqueléticas/cirurgia , Radiografia , Costelas/anormalidades , Costelas/diagnóstico por imagem , Escoliose/congênito , Escoliose/diagnóstico por imagem , Vértebras Torácicas/anormalidades , Vértebras Torácicas/diagnóstico por imagem , Parede Torácica/diagnóstico por imagem , Parede Torácica/cirurgia , Toracoplastia/efeitos adversos , Toracostomia/efeitos adversos , Titânio
15.
Ann Thorac Surg ; 98(1): 291-6, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24857855

RESUMO

BACKGROUND: New materials (NM) such as titanium plates, cryopreserved grafts, and acellular collagen matrices are being increasingly used for chest wall reconstruction as a result of improved incorporation while maintaining structural stability and reduced need for removal from infected areas. Direct comparisons between NM and conventional materials (CM) in terms of local morbidity and need for prosthesis removal are lacking. METHODS: Between January 2005 and July 2013, 109 procedures were performed to remove chest wall tumors in 86 patients. Of these, 32 underwent complex chest wall reconstructions owing to either recurrence, defect extension (greater than 3 ribs or >100 cm2) or local conditions (ie, previous irradiation or infection). New materials and CM (ie, polytetrafluoroethylene and methyl methacrylate) were used in 17 (53%) and 15 (47%) patients, respectively. Of the 32 patients included in the high complexity group, 23 patients did not exhibit any postoperative complications (72%). However, 9 patients (28%) underwent both a first and a second reoperation after a median interval of 4 months from the first procedure (range, 7 days to 60 months). Vacuum-assisted closure (VAC) was instituted in all patients as a means to control sepsis and facilitate space obliteration with healthy tissue. RESULTS: In 7 patients the reason for reintervention was local wound complications. In 4 of 7 patients, the prosthesis had to be removed (3 CM and 1 NM, 4.6% of the whole series; 12.5% in the high complexity group, 5.9% for NM and 20% for CM). The median time to complete chest wall healing after VAC in patients with local sepsis was 14 months (range, 5 to 60 months). All patients are currently alive and well except for 1 who died 11 months after complete chest wall healing as a result of dissemination of metastatic chondrosarcoma. At univariate analysis, predictors of overall and grade 2 or less morbidity according to the Common Terminology Criteria for Adverse Events version 4.0 were first (p=0.038) and second (p=0.015) redo operations. Conversely, patients with a body mass index of less than 25 kg/m2 (p=0.049) undergoing one (p=0.032) or two reconstructions (p=0.00047) with combined materials (p=0.00029) were more likely to experience local wound complications and require VAC. On multiple regression analysis, redo operations (first, p=0.032; second, p=0.00047) and the use of combined (synthetic and biologic) materials (p=0.0029) were confirmed to be related to an increased incidence of wound complications. CONCLUSIONS: Multiple redo operations after complex chest wall reconstruction performed with a combination of NM and CM may be associated with an increased incidence of local wound complications. Nevertheless, in these cases, the use of NM and VAC yielded a low rate (5.8% versus 20% with CM) of prosthesis removal while achieving complete wound healing.


Assuntos
Tratamento de Ferimentos com Pressão Negativa/estatística & dados numéricos , Próteses e Implantes , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Neoplasias Torácicas/cirurgia , Toracoplastia/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Estudos Retrospectivos , Toracoplastia/instrumentação , Resultado do Tratamento , Adulto Jovem
17.
Eur J Orthop Surg Traumatol ; 24 Suppl 1: S103-10, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24532048

RESUMO

BACKGROUND: Major left thoracic (LT) curve is an atypical type in adolescent idiopathic scoliosis (AIS) and showed independent clinical characteristics and natural history compared to major right thoracic (RT) curve. However, it's unclear whether the convexity of major thoracic curve would affect the surgical outcomes and risk of complications. A retrospective follow-up study was conducted to investigate whether the convexity of major thoracic curve would affect the surgical outcomes of patients with main thoracic AIS. METHODS: Twelve LT-AIS patients underwent corrective spinal instrumentation and fusion were retrieved, and twelve patients with main RT-AIS matched for gender, chronological age, curve type, magnitude and surgical strategy were selected as control. All patients underwent at least 2-year follow-up. The pre- and post-operative radiographic parameters, intraoperative data and functional outcome assessed by Scoliosis Research Society questionnaire 22 (SRS-22) were analyzed and compared between two groups. RESULTS: Patients with LT- and RT-AIS presented with similar magnitudes of thoracic curves, flexibility, fusion level and correction rate. Compared with RT-AIS, patients with LT-AIS showed longer operation time (average, 364 vs. 348 min) and larger amount intraoperative estimated blood loss (2,060 vs. 1,720 ml) although the differences were not statistically significant (p > 0.05). With at least 2-year follow-up, patients in two groups showed comparable loss of correction, coronal and sagittal balance, and the sagittal profiles. With regard to functional outcome, the scores of five categories of SRS-22 questionnaire were similar between two groups. No neurological or vascular complication was observed in these patients. CONCLUSIONS: The radiographic and functional outcomes of LT-AIS patients underwent operation were comparable to those with RT-AIS. Longer operation time and more intraoperative blood loss may be expected in instrumentation and fusion for patients with LT-AIS, which might be because of the inconvenience on the surgical procedure.


Assuntos
Escoliose/cirurgia , Vértebras Torácicas/cirurgia , Adolescente , Feminino , Humanos , Cifose/diagnóstico por imagem , Cifose/patologia , Cifose/cirurgia , Masculino , Radiografia , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/patologia , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Inquéritos e Questionários , Toracoplastia/efeitos adversos , Toracoplastia/métodos , Resultado do Tratamento
18.
Ann Thorac Cardiovasc Surg ; 20 Suppl: 535-8, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-23411837

RESUMO

We report a rare case of chronic expanding hematoma of thorax extended to the neck. An 83-year-old man with a history of Lucite ball plombage and thoracoplasty of bilateral thorax was admitted with numbness of left upper extremity. In 6 months, left supraclavicular fossa was gradually bulged like tumor. The lesion was diagnosed as chronic expanding hematoma. Surgically, Lucite balls were removed with surrounding hematoma debris and fluid, and neck hematoma, which was slightly communicated to the thorax, was extirpated. We discussed the genesis of this hematoma and its extension to the neck.


Assuntos
Hematoma/diagnóstico , Polimetil Metacrilato/efeitos adversos , Doenças Torácicas/diagnóstico , Toracoplastia/efeitos adversos , Tuberculose Pulmonar/cirurgia , Idoso de 80 Anos ou mais , Doença Crônica , Progressão da Doença , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Masculino , Pescoço , Reoperação , Doenças Torácicas/etiologia , Doenças Torácicas/cirurgia , Toracoplastia/métodos , Tórax , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculose Pulmonar/diagnóstico
19.
J Orthop Surg Res ; 8: 32, 2013 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-24007407

RESUMO

BACKGROUND: The patients with extremely severe spinal deformity are commonly considered high-risk candidates for surgical treatment because of their underlying lung disease. Currently, little has been reported about the postoperative pulmonary complication events in this population. This retrospective study sought to evaluate preoperative pulmonary function tests in the surgical treatment of extremely severe scoliosis. METHODS: Preoperative forced vital capacity (FVC), FVC ratio, forced expiratory volume at the end of the first second (FEV1), FEV1 ratio, peak expiratory flow (PEF), and PEF ratio were performed and evaluated on 60 patients with extremely severe scoliosis (coronary main Cobb angle ≥100°). RESULTS: Among the 60 patients, 11 (18.3%), 13 (21.7%), and 22 (36.7%) had severe, moderate, and mild pulmonary dysfunction, respectively. Compared with the moderate and mild scoliosis groups, significant differences were observed in Cobb, FVC, FVC ratio, FEV1, FEV1 ratio, and PEF ratio in the extremely severe scoliosis group. Various postoperative pulmonary complications occurred in nine cases (15%). Patients with severe or moderate dysfunction as measured by the FVC ratio had a higher incidence of postoperative pulmonary complications. A transthoracic procedure was not related to postoperative pulmonary complications, but thoracoplasty significantly increased the incidence of postoperative pulmonary complications (P < 0.001, OR = 20, 95% CI = 3.45-115.97). DISCUSSION: Pulmonary function was impaired in extremely severe scoliosis. Patients with severe restrictive pulmonary dysfunction had a higher incidence of postoperative pulmonary complications. Thoracoplasty was an important risk factor in the prediction of postoperative pulmonary complications.


Assuntos
Pulmão/fisiopatologia , Escoliose/fisiopatologia , Escoliose/cirurgia , Adolescente , Adulto , Criança , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Pico do Fluxo Expiratório , Complicações Pós-Operatórias , Cuidados Pré-Operatórios/métodos , Testes de Função Respiratória/métodos , Doenças Respiratórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Toracoplastia/efeitos adversos , Capacidade Vital/fisiologia , Adulto Jovem
20.
Thorac Cardiovasc Surg ; 61(7): 626-30, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23990141

RESUMO

BACKGROUND: The objective of this study is to perform a retrospective analysis of our experience in using muscle flaps and thoracomyoplasty for unresectable primary pulmonary abscesses. MATERIALS AND METHODS: Between January 1, 2003, and January 1, 2012, we have used different muscle flaps and thoracomyoplasty in 15 patients with unresectable primary pulmonary abscesses. Muscle transposition was used alone (3 cases) or during thoracomyoplasty procedures for lung abscesses complicated with empyema (12 cases). The objective of the procedure was complete obliteration of the diseased space, with additional limited thoracoplasty being required in 12 out of 15 patients (average resected ribs: 3.7); bronchial fistula were encountered in 9 patients and were closed-reinforced using muscle flaps. The following parameters were followed: mortality, morbidity, intensive care and overall postoperative hospitalization, recurrence, and late sequelae. RESULTS: We have encountered one postoperative death (6.7%) and an overall 46.7% morbidity. Intensive-care unit stay ranged between 1 and 5 days with a median of 2. Overall postoperative hospitalization ranged between 22 and 46 days, with a median of 32 days. At late 1-year follow-up, we encountered no recurrence and no major chest deformity with a moderate limitation of shoulder mobility in two patients. CONCLUSION: Space-filling procedures are a valuable solution for unresectable primary pulmonary abscesses, allowing the avoidance of open drainage and pleuropneumonectomy. The extensive mobilization of the flaps offers a good-quality biological material with considerable volume.


Assuntos
Abscesso Pulmonar/cirurgia , Músculo Esquelético/cirurgia , Retalhos Cirúrgicos , Toracoplastia , Fístula Brônquica/etiologia , Fístula Brônquica/cirurgia , Empiema Pleural/etiologia , Empiema Pleural/cirurgia , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Abscesso Pulmonar/complicações , Abscesso Pulmonar/diagnóstico , Abscesso Pulmonar/mortalidade , Estudos Retrospectivos , Toracoplastia/efeitos adversos , Toracoplastia/mortalidade , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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