• Archives of Plastic Surgery
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• 제48권5호
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• pp.498-502
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• 2021

Total and subtotal sternectomy oncological defects can result in large deficits in the chest wall, disrupting the biomechanics of respiration. Reviewing the current literature involving respiratory function and rib motion after sternectomy, autologous rigid reconstruction was determined to provide the optimal reconstructive option. We describe a novel technique for sternal defect reconstruction utilizing a double-barrel, longitudinally oriented, vascularized free fibula flap associated with rib titanium plates fixation. Our reconstructive approach was able to deliver a physiological reconstruction, providing rigid support and protection while allowing articulation with adjacent ribs and preservation of chest wall mechanics.

• Archives of Plastic Surgery
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• 제37권5호
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• pp.589-594
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• 2010

Purpose: Full thickness skin grafts are useful in the reconstruction of facial skin defects when primary closure is not feasible. Although the supraclavicular area has been considered as the choice of donor site for large facial skin defect, many patients are reluctant to get a neck scar and some patients do not have enough skin to cover the defect owing to the same insult occurred to the neck such as burn accident. We present several cases of reconstruction of facial skin defects by freehand full-thickness skin graft from anterolateral chest wall resulting aesthetically acceptable outcome with lesser donor site morbidity. Methods: Retrospective review was performed from March, 2007 to September, 2009. 15 patients were treated by this method. Mean age was 31.5 years. The ethiology was congenital melanocytic nevus in 7 cases, capillary malformation in 5 cases and burn scar contracture in 3 cases. Mean area of lesion was measured to 67.3 cm2 preoperatively. The lesion was removed beneath the subcutaneous fatty tissue layer. The graft was not trimmed to be thin except defatting procedure. For the larger size of defect, two pieces of grafts were harvested from both anterolateral chest wall in separation and combined by suture. Results: The mean follow up period was 9.7 months. All the grafts survived without any problem except small necrotic areas in 4 cases, which healed spontaneously under conventional dressings in 6 weeks postoperatively. Color match was relatively excellent. There were 2 cases of hyperpigmentation immediately, but all of them disappeared in a few months. Conclusion: In cases of large facial skin defects, the anterolateral chest wall may be a good alternative choice of full-thickness skin graft.

• Journal of Chest Surgery
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• 제27권1호
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• pp.68-71
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• 1994

A tracheo-esophageal fistula following from blunt chest trauma is one of less common lesion and few guidelines are available to direct its optimal management. Herein, we report a 24-year-old man injured in a motor vehicular accident sustained a nonpenetrating double blowout injury of the thorax and large tracheoesophageal fistula occurred. Tracheal defect required resection and reconstruction, of which the membranous portion underwent closure with borrowed adjacent esophageal wall primarily and substernal left colon interposition was performed 4 weeks later.

• Archives of Plastic Surgery
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• 제36권4호
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• pp.397-405
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• 2009

Purpose: Soft tissue defect of anterior chest wall is caused by trauma, infection, tumors and irradiation. To reconstruct damaged anterior chest wall does require to consider the patient's body condition, the cause, the location, the depth and the size of deletion, the circulation of surrounding tissue and minimization of functional and cosmetic disability. In this report, we suggest the algorithm of configuration for reconstruction methods. Methods: A retrospective study of 20 patients who underwent anterior chest wall reconstruction with pedicled musculocutaneous flap and fasciocutaneous flap was conducted. We collected the information of the patient's body condition, the cause, the size, the depth and the location of deletion, implemented flap and complication. We observed and evaluated flap compatibility, functional and cosmetic results. Patients completed survey about the extent to their satisfaction. Result: Follow up period after surgery was from 6 to 26 months, survival of flap were confirmed in all of patients' case. Two cases of local necrosis, one case of wound disruption were reported, but all these were cured by the debridement and primary closure. One hematoma and one seroma formation were observed in donor site. Longer surgery time, more bleeding amount and more transfusion volume were reported in the group of musculocutenous flap. Conclusion: Long term follow up result showed the successful reconstruction in all patients without recurrence and with minimal donor site morbidity. In addition, the patients' satisfaction for cosmetic and functional results were scaled relatively higher. This confirmed the importance of reconstruction algorithm for the chest wall reconstruction.

• Journal of Chest Surgery
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• 제6권1호
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• pp.51-56
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• 1973

This is one case report of successful resection of the aneurysm of the thoracic aorta, which det-ected by thoractomy unexpectedly, in the Department of Thoracic Surgery, Hanyang University Hospital. The patient was a 34 years old woman and subjective complaints was not related with the aneurysm. Chest film showed a small round hazy shadow in the left margin of the upper posterior mediastinum. A saccular aneurysm located on the descending thoracic aorta, 7cm distal to the left subclavian artery and arouse from the antero-lateral wall of the aorta. Excision of the saccular aneurysm was performed by cross clamping the descending aorta above and below the aneurysm, and then the defect of the aortic wall was closed by aortorrhaphy with continuous suture. Crossclamping time was required 15 minute. Histopathologically, the wall of the aneurysm consisted of all layers of the arterial wall, that is, intima, media and adventitia. Postoperative course was uneventful and aortogram showed good continuity of the blood flow of the entire aorta.

• Journal of Chest Surgery
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• 제37권6호
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• pp.536-538
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• 2004

선천성 심기형과 흉벽기형이 동반되어 있는 경우 이 두 질환을 동시에 수술하는 경우에 변형된 늑연골의 광범위한 절제에 따른 합병증이 단점으로 지적되고 있다. 본원 흉부외과에서는 부분 방실중격 결손증과 오목가슴이 동반된 8세 환아에서 개심술 시에 Nuss 술식을 이용하여 오목가슴을 교정함으로써 광범위한 늑골절제에 따른 수술시간의 지연이나 출혈, 흉벽의 불안정성 등의 단점없이 좋은 결과를 얻었기에 이를 보고하는 바이다.

• Journal of Chest Surgery
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• 제33권4호
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• pp.333-337
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• 2000

Malignant fibrous histiocytoma(MFH) is a deep-seated pleomorphic sarcoma, which occurs principally as a mass of the extremities, abdominal cavity, or retroperitoneum in adults. However, it only rarely occurs in the chest wall. An 85-year-old man had undeergone excision of a small mass on the right posterior chest wall under local anesthesia 14 months age. However, the lesion did not heal and the mass recurred. He was referred to our hospital after the mass had grown to a size of 10.5$\times$8$\times$4cm with a 3$\times$3cm skin defect. Intraoperative frozen biopsy revealed MFH. An en-bloc wide resection and thin-thickness skin graft from his thigh were performed. Although distant metastasis to the lund developed 14 months later and the patient died 2 months later, there was no local recurrence. Thin-thickness skin graft is a simple method for a wide range skin defect, especially in the old age. He recovered in good condition without any physical disabilities.

• Journal of Chest Surgery
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• 제30권7호
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• pp.729-732
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• 1997

흉벽에 발생한 악성 말초신경초종은 미국에서 Mark등a(1991)이 17례를 보고하였으나 한국에서는 아직까 지 발표된 예가 없다. 악성 말초신경초종은 악성 연부 육종의 10%에서 발생되며 대개 20세에서 50세 사이에 발생한다. 악성 말 초신경초종은 주로 좌골신경, 상완신경총, 천추총과 연관되어 발생하며, 가장 흔한 발생위치는 상지와 하지 의 근위부, 체간 등이며 드물게는 두경부에도 발생한다. 악성 연부조직 육종의 치료는 저급육종(low grade sarcoma)의 경우는 종양의 절제만으로 치유 가능하나 고급육종(high grade sarcoma)의 경우는 광범위 절제가 요구된다. 저자의 경우에는 50세 남자에서 다발성 거대종괴가 좌측 흉벽에 광범위하게 있었으며 병리소견상 저급 악 성 말초신경초종으로 판명되었다. 종괴들을 절제한후 발생한 흉벽결손은 15$\times$8 cm정도 였으며 Teflon을 이용하여 재건하였다. 수술후 환자 는 큰 문제 얼이 회복되었다.

• Archives of Plastic Surgery
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• 제35권2호
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• pp.214-218
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• 2008

Purpose: Reconstruction of microtia using costal cartilage graft is commonly used technique nowadays. The chest wall depression at the donor site after the graft, however, has been noticed in many articles. Prevention or correction technique for the depression at the donor site also has been reported and we also have been concerned about the problem. This article is a case report about a new technique preventing chest wall depression after costal cartilage graft. Methods: We selected total 15 microtia patients who visited our clinic, from December 2005 to July 2007. They were 10 male and 5 female patients and the mean age was 11.9 years. The average follow up period was 9.2 months(2 to 15 months). We used 6, 7, and $8^{th}$ costal cartilage for microtia reconstruction. And then we turned over pivot of cartilage resection margin, after bihalving costal cartilage involving about 5-6 cm of $6^{th}$ and $7^{th}$ rib bone. After microtia reconstruction, chest donor sites were evaluated by physical examination and radiography. Results: Postoperative depression at the donor site was much less when the costal cartilage turnover technique was performed. Postoperative physical examination and three dimensional reconstruction CT showed that the rest part of rib bone was turned over and it supported the soft tissue defect during respiration. Conclusion: We expect that the turnover rib bone will not be absorbed after graft, as well as offering mechanical support, compared to the other reports.

• Journal of Chest Surgery
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• 제54권5호
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• pp.400-403
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• 2021

A 63-year-old patient was admitted with a sternal fracture and mass. On evaluation, most of the body of the sternum had been destroyed by a tumor. Radical resection of the sternum was performed and part of the major pectoral muscles adherent to the sternal tumor was also resected. The chest wall defect was reconstructed with mesh, bone cement, and a titanium rib plate system. Reconstruction with this method seemed to be an appropriate procedure to prevent instability of the chest wall.