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PubMedDate not supplied

[Clinical aspects and problems in thoracic dystrophy].

We report about a child with Jeune-syndrome in whom surgical enlargement of the thorax at the age of 4 months was performed. In the beginning there was a significant improvement of the respiratory situation. Due to resorption of the interposed ribs there was again a shrinking of the thorax and a deterioration in the child's condition. A reoperation at the age of 8 months couldn't improve the situation anymore, because at that time the child had already additional problems such as pulmonary hypertension and broncho-pulmonary dysplasia. We overview the literature and line out our opinion about the indication for surgical enlargement of the thorax in children with Jeune syndrome.

Asphyxia Neonatorum↗
PubMed1981

[Indication and operative technique in chest deformities (author's transl)].

From 1956-1980, 1112 thoracic deformities were operated on in the Surgical Clinic of the University of Erlangen. These are divided into 11 different types, according to whether a funnel chest (4 types), a pigeon chest (4 types), combinations of these, or a split-sternum was present. The indication for operation is given in patients where the depression is more than 25% of the a/p diameter of the chest. Scolioses - deformities of the spinal column - are found in 40-50%, depending on the type of funnel chest. They are rarely found in small children, but are fixed and irreversible in teenagers and older patients. Reconstruction of the thorax is carried out through a double-segment chondrotomy parasternal and at the apex of the funnel, using a horse-shoe-shaped metal support. Average length of stay in hospital is 7-10 days. Alternative procedures are Rehbein's operation, or Ravitch and Hecker's procedure. Postoperative physiotherapy is extremely important. Late results, on average 10.5 years after operation, showed recurrence of the funnel in 2.1% of cases, partial recurrence, ugly scars and cartilage nodules in 6.7%.

Adolescent↗
PubMed2002

Sternal reconstruction with synthetic mesh and metallic plates for high grade tumours of the chest wall.

OBJECTIVE: To present our experience of reconstruction of the chest wall after sternectomy for high grade tumours. DESIGN: Retrospective study. SETTING: University hospital, Italy. SUBJECTS: 18 patients who required sternectomy for high grade tumours. INTERVENTIONS: After wide resection of the tumour the sternum and chest wall were reconstructed with polypropylene (Marlex) mesh and mouldable titanium plates. Pedicled muscle flaps were used to complete the reconstruction. MAIN OUTCOME MEASURES: Morbidity, mortality, and outcome. RESULTS: The 18 tumours were chondrosarcomas (n = 7); osteosarcomas, radiation-induced sarcomas, and local recurrences after breast cancer (n = 2 each); and angiosarcoma, Ewing sarcoma, liposarcoma, malignant fibrous histiocytoma, and metastatic renal carcinoma (n = 1 each). One patient died in hospital. Two patients developed wound infections, one required repeated aspirations of a pleural effusion, and one patient later developed loosening of the plate that had been sutured to the clavicular stump. At the time of follow-up (mean 32 months, range 12-74) 16 patients were alive, all of whom had returned to their normal life style. CONCLUSIONS: The technique is easy to follow and has the advantages of a short hospital stay and good local control. It obviates the need for postoperative mechanical ventilation, and means that patients are not prevented from working because of incapacity.

Adult↗
PubMed1988

Coverage of chest wall and pelvic defects with the external oblique musculofasciocutaneous flap.

The external oblique muscle, its fascia, and overlying skin have comprised flaps that have been used successfully in reconstructive surgery of various defects in the past. This flap provides good coverage for lower and upper chest wall defects to the level of the ipsilateral fourth rib. It provides skin of a similar color and texture and of large quantity. The skin of the flap is innervated; thus, sensation can be maintained. The remaining flat abdominal musculature and fascia maintain the integrity of the abdominal wall after transposition. We demonstrate that the external oblique musculofasciocutaneous flap can also be rotated in an inferior direction to close large hemipelvectomy defects in the absence of the usual ipsilateral thigh musculature.

Abdominal Muscles↗
PubMed1995

Closure of massive chest wall defects after full-thickness chest wall resection.

We report an unusual repair of a massive chest wall defect resulting from resection of a chronic ulcer after radiation therapy for stage IV breast carcinoma. The defect was 690 cm2 and included the body of the sternum, 10 ribs, and the anterior portion of the diaphragm. Chest wall reconstruction was accomplished with multiple flaps: a pectoralis major advancement flap, a reversed abdominoplasty, an omental flap, and a latissimus dorsiscapular-parascapular musculofasciocutaneous (hemiback) flap. Skeletal reconstruction with prosthetic material or bone grafts was not performed in this patient. The problems associated with complex chest wall reconstructions are discussed.

Aged↗
PubMed1990

Management of close-range shotgun injuries to the chest by diaphragmatic transposition: case reports.

A method of reconstructing the chest wall following close-range shotgun injuries is described. This technique requires detaching the diaphragm peripherally and suturing it above the chest wall defect, resulting in an intact chest cavity and an abdominal wall defect. This latter problem can then be addressed by a variety of standard methods. Two patients are presented with excellent long-term results of diaphragmatic transposition, which should be in the armamentarium of all surgeons who deal with trunk trauma.

Adult↗
PubMed1999

Comparison of anterior and posterior instrumentation for correction of adolescent thoracic idiopathic scoliosis.

STUDY DESIGN: This was a prospective study of two cohort groups of patients (one group receiving anterior instrumentation and the other posterior instrumentation) receiving treatment for thoracic idiopathic scoliosis. OBJECTIVE: To present the 2-year postoperative results of a prospective multicenter study comparing the use of anterior instrumentation with that of posterior multisegmented hook instrumentation for the correction of adolescent thoracic idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Despite reports of satisfactory results, problems have been reported with posterior systems, including worsening of the lumbar curve after surgery and failure to correct hypokyphosis. Theoretically, the advantages of anterior instrumentation include prevention of lumbar curve decompensation by shortening the convexity of the thoracic curve. In addition, by removing the disc, better correction of thoracic hypokyphosis could be obtained. METHODS: Seventy-eight patients who underwent an anterior spinal fusion using flexible threaded rods and nuts (Harms-MOSS instrumentation, De Puy-Motech-Acromed, Cleveland, OH) were analyzed and compared with 100 patients who underwent posterior spinal fusion with multisegmented hook systems. Parameters of comparison included coronal and sagittal correction, balance, distal lumbar fusion levels, and complication. All patients had idiopathic thoracic curves of King Types II to V. The average age at surgery was 14 years in each group, the average preoperative curve 57 degrees, and the minimum duration of follow-up for all patients 24 months. All data were collected prospectively and analyzed via Epl into statistical analysis (Centers of Disease Control, Atlanta, GA). RESULTS: Average coronal correction of the main thoracic curve was 58% in the anterior group and 59% in the posterior group (P = 0.92). Analysis of sagittal contour showed that the posterior systems failed to correct a preoperative hypokyphosis (sagittal T5 to T12 less than 20 degrees) in 60% of cases, whereas 81% were normal postoperatively in the anterior group. However, hyperkyphosis (sagittal T5 to T12 greater than 40 degrees) occurred after surgery in 40% of the anterior group when the preoperative kyphosis was greater than 20 degrees. Postoperative coronal balance was equal in both groups. An average of 2.5 (range, 0-6) distal fusion levels were saved using the anterior spinal instrumentation according to the criteria used for determining posterior fusion levels in this study. Selective fusion of the thoracic curve (distal fusion level T11, T12, L1) was performed in 76 of 78 patients (97%) in the anterior group as compared with only 18 of 100 (18%) in the posterior group. Surgically confirmed pseudarthrosis occurred in 4 of 78 patients (5%) in the anterior group and in 1 of 100 patients (1%) in the posterior group (P = 0.10). Loss of correction greater than 10 degrees occurred in 18 of 78 patients (23%) in the anterior group and in 12 of 100 patients (12%) in the posterior group (P = 0.01). Implant breakage occurred in 24 patients (31%) of the anterior group and in only 1 patient (1%) of the posterior group. CONCLUSIONS: 1) Coronal correction and balance were equal in both the anterior and posterior groups, even though the anterior group had the majority of curves (97%) fused short or to L1, whereas only 18% were fused short or to L1 in the posterior group. 2) In the anterior group there was a better correction of sagittal profile in those with a preoperative hypokyphosis less than 20 degrees. However, hyperkyphosis (with a mean of 54 degrees) occurred in 40% of those in the anterior group with a preoperative kyphosis of more than 20 degrees. 3) An average of 2.5 lumbar levels can be saved with anterior fusion and instrumentation according to the criteria used for choosing posterior fusion levels in this study. 4) Using the 3.2-mm flexible rod in this study, loss of correction, pseudarthrosis, and rod breakage were unacceptably highe

Adolescent↗