• Archives of Reconstructive Microsurgery
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• 제23권2호
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• pp.89-92
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• 2014

An 8-year-old girl diagnosed with dilated cardiomyopathy and Russell-Silver syndrome was admitted to our pediatric intensive care unit due to low cardiac output and multiple-organ dysfunction. The patient was placed on the heart transplant waiting list and extracorporeal membrane oxygenation was performed as a bridge to transplantation. After 17 days, heart transplantation was performed. The donor was a 46-year-old female (weight, 50 kg; height, 150 cm). The donor:recipient weight ratio was 3.37:1. Because the dimension and volume of the recipient's thoracic cage were insufficient, the sternum could not be closed. Nine days after transplantation, the patient underwent delayed sternal closure. To obtain adequate space, we left the sternum 4.5 cm apart from each margin using four transverse titanium plates. A transverse rectus abdominis musculocutaneous flap was chosen to cover the wound. Due to the shortage of donors, a size-mismatched pediatric heart transplantation is sometimes unavoidable. Closure of the opened sternum of a transplant recipient can be challenging. Sternal reconstruction after an extremely oversized heart transplantation with transverse titanium plate fixation and a musculocutaneous flap can effectively achieve sternal closure and stability.

• Archives of Plastic Surgery
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• 제37권6호
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• pp.736-741
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• 2010

Purpose: Radical surgical extirpation in advanced breast cancer patients produces extensive loss of skin with large defects requiring plastic surgical procedures for the closure. Many reconstructive methods exist, the choice of which depends upon the characteristic of the wound, extent of resection and patient comorbidities. For adequate coverage of the large skin defects following resection of advanced breast cancer, current authors have performed a thoracoabdominal flap. Methods: From August 2008 to June 2009, 4 cases of thoraco-abdominal flap were performed for chest wall reconstruction after mastectomy of advanced breast cancer. Flap dissection was entirely performed in a subfascial plane and the flap involving the external oblique abdominal muscle. The flap was rotated clockwise in left chest wall defects and counterclockwise in right chest defects and the donor site was closed directly. Results: Their mean age, 55.7 years and the average follow-up interval was 9 months. Patients' oncologic status ranged from stage IIIc to stage IV, it was classified according to the TNM staging system. Flap dimensions ranged between $15{\times}15$ and $25{\times}25\;cm$. One flap sustained a partial loss at the distal margin and revision with pectoralis major musculocutaneous island flap. Conclusion: Large chest wall reconstructions are usually required after radical excision of advanced cancer stages patients with poor general conditions. Thoracoabdominal flap is a simple, quick single-stage procedure, and offer to patient fast recovery, low complication rate, enabling further concomitant adjuvant therapy.

• Archives of Plastic Surgery
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• 제33권1호
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• pp.113-115
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• 2006

The sternalis muscle is an uncommon variation in the anterior chest wall which is located superficial to the pectoralis major, coursing vertically almost parallel to the sternum. It exists unilaterally or bilaterally, as thin muscle strips or a broad band of muscles. We report two cases of skin sparing mastectomy and immediate breast reconstruction in which the sternalis muscle was encountered. This unusual variation might puzzle radiologists to mistake it for a tumor or an abnormal bulging of the pectoralis. Surgeons also must not be surprised to encounter this muscle during surgery of the breast or pectoralis and keep the appropriate dissection plane.

• Archives of Plastic Surgery
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• 제33권6호
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• pp.773-775
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• 2006

Purpose: The sternalis muscle is an accessory muscle of the anterior chest wall. This is a rare anatomic variant reported in approximately 8 percent of the population, with variation among races. While several anatomic studies of the sternalis muscle exist, nothing in the literature addresses the implications of this muscle on staged breast reconstruction with implant. Methods: We encountered two consecutive patients with a left sternalis muscle who underwent immediate staged breast reconstruction with a tissue expander. We offer a strategy for dealing with this rare, but known, anatomic variant during staged implant reconstruction. Firstly, recognizing the presence of a sternalis muscle mandates the elevation of the pectoralis major muscle and the sternalis muscle in continuity. Secondly, slight modifications must be made during the submuscular dissection to create a properly placed pocket for the tissue expander. Results: While our encounters with this anatomic variant are few, our experiences with two consecutive patients illustrate that the reconstructive surgeon must be familiar with the sternalis muscle and be prepared to adapt his or her technique for tissue expander placement when faced with this accessory muscle. Conclusion: To date, no reports exist in the literature describing the operative implications of this anatomic variant. We offer our technique for dealing with this accessory muscle during staged implant reconstruction of the breast.

• Archives of Plastic Surgery
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• 제42권3호
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• pp.288-294
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• 2015

Background Surgical ablation for locally advanced breast cancer results in large chest wall defects, which can then be managed with local flaps or skin grafts. The purpose of this article is to evaluate the outcomes of three types of local skin flaps. Methods Among 25 local flaps in 24 patients, 6 were bilateral advancement (BA) flaps, 9 were thoracoabdominal (TA) flaps, and 10 were thoracoepigastric (TE) flaps. Clinical outcomes were compared including complications, the need for a secondary surgical intervention, and the timing of adjuvant therapy. Results The mean defect size was $436.2cm^2$. Two patients with TA flaps and 6 patients with TE flaps developed distal flap necrosis, and skin grafts were needed to treat 2 patients with TE flaps. Radiation was administered to the BA, TA, and TE patients after average postoperative durations of 28, 30, or 41 days, respectively. The incidence of flap necrosis tended to be higher in TE patients, which lead to significant delays in adjuvant radiation therapy (P=0.02). Conclusions Three types of local skin flaps can be used to treat large chest wall defects after the excision of locally advanced breast cancer. Each flap has its own merits and demerits, and selecting flaps should be based on strict indications based on the dimensions and locations of the defects.

• Journal of Chest Surgery
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• 제44권3호
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• pp.247-249
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• 2011

We report a case of pseudo-pseudoaneurysm, which is a very rare complication of myocardial infarction. A 69-year-old man was admitted to our clinic with chest tightness and dyspnea. He had undergone aortic valve replacement with a pericardial bioprosthetic valve, ring mitral annuloplasty, and reconstruction of an aortic annular defect due to infective endocarditis with bovine pericardium 4 years prior. Echocardiography and computed tomography showed pericardial effusion and a 16-mm cavity at the anterolateral wall of the left ventricle. Magnetic resonance imaging suggested either pseudo-pseudoaneurysm or myocardial abscess. We successfully repaired the myocardial defect using a patch made from a vascular graft with pledgeted horizontal mattress sutures under cardiopulmonary bypass.

• Journal of Chest Surgery
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• 제55권2호
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• pp.171-173
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• 2022

A 65-year-old man underwent right trisectionectomy of the liver and reconstruction of the chest wall and diaphragm with a 2-mm Gore-Tex membrane due to recurrent hepatocellular carcinoma. After 3 years, the Gore-Tex membrane in the diaphragm migrated to the abdominal cavity and perforated the colon. We report a rare complication of a Gore-Tex membrane after diaphragm repair.

• Journal of Chest Surgery
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• 제25권6호
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• pp.581-587
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• 1992

Tracheoesophageal fistula[TEF] is a rare but life-threatening lesion that may occur from ventilation with a cuffed tube. It occurs most frequently when an inlying esophageal tube is also being used-usually for feeding purposes. The mechanism of injury appears to be pressure experted on the tracheal wall by the cuff, which then compresses the "party wall" of the trachea and esophagus against the foreign body that lies in the esophagus. The patient was 32 years old female who had been receiving a treatment of respiratory failure induced by postoperative sepsis with assist ventilator and nasogastric tubal feeding. Sudden attack of abdominal gas distention and massive drainage of gas through N-G tube were developed during assist ventilation in that patient, so we diagnosed as tracheal stenosis with a tracheoesophageal fistula induced by prolonged endotracheal intubation We performed tracheal reconstruction and primary closure of perforated esophagus after weaning ventilator. The postoperative course was uneventiful.eventiful.

• Journal of Chest Surgery
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• 제30권6호
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• pp.636-640
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• 1997

기관 식도루의 발생은 대개 카프 주변의 압력에 의한 기관후벽의 궤양 및 괴사에 의한 식도와의 누공 발생에 의하여 생긴다. 본 교실에서는 23세의 여자 환자에서 심폐소생술을 위한 기관삽관후 12일째 발견한 기관식도루 1예를 치험 하였다. 기관식도루는 자연 치유가 드물어 수술로서 교정을 시행하여야 하며 진단 즉시 수술해야 하는 것이 원칙이나 본 예에서는 환자의 전신 상태가 쇠약하여 수술을 지연하였으며 기관 재건술후 재건 부위는 양호하였으나 위루관 제거부위 누출에 의한 복막염 및 패혈증으로 사망한 1예를 보고한다.

• Archives of Plastic Surgery
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• 제41권1호
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• pp.57-62
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• 2014

Background Achieving symmetry is a key goal in breast reconstruction. Anatomically shaped tabbed expanders are a new tool in the armamentarium of the breast reconstruction surgeon. Suture tabs allow for full control over the expander position and thus inframammary fold position, and, in theory, tabbed expanders mitigate many factors responsible for poor symmetry. The impact of a tabbed expander on breast symmetry, however, has not been formally reported. This study aims to evaluate breast symmetry following expander-implant reconstruction using tabbed and non-tabbed tissue expanders. Methods A chart review was performed of 188 consecutive expander-implant reconstructions that met the inclusion criteria of adequate follow-up data and postoperative photographs. Demographic, oncologic, postoperative complication, and photographic data was obtained for each patient. The photographic data was scored using a 4-point scale assessing breast symmetry by three blinded, independent reviewers. Results Of the 188 patients, 74 underwent reconstruction with tabbed expanders and 114 with non-tabbed expanders. The tabbed cohort had significantly higher symmetry scores than the non-tabbed cohort ($2.82/4{\pm}0.86$ vs. $2.55/4{\pm}0.92$, P=0.034). Conclusions The use of tabbed tissue expanders improves breast symmetry in tissue expander-implant-based breast reconstruction. Fixation of the expander to the chest wall allows for more precise control over its location and counteracts the day-to-day translational forces that may influence the shape and location of the expander pocket, mitigating many factors responsible for breast asymmetry.