Chest wall reconstruction is a surgical procedure aimed at restoring the integrity and function of the chest wall, which may be damaged due to trauma, cancer, infection, or congenital defects. The chest wall plays a v...Chest wall reconstruction is a surgical procedure aimed at restoring the integrity and function of the chest wall, which may be damaged due to trauma, cancer, infection, or congenital defects. The chest wall plays a vital role in protecting the thoracic organs, supporting the respiratory system, and maintaining the shape of the chest. Therefore, any defect or deformity of the chest wall can have significant functional and aesthetic consequences for the patient. The authors present a case report at Kenyatta National Hospital (KNH) of a dyspneic 47-year-old male patient with a right anterolateral chest wall defect post-pneumonectomy previously complicated by bronchopleural fistula. Past attempts at the chest wall reconstruction had utilized the ipsilateral latissimus dorsi muscle, pectoralis major muscle, and the omental pedicled flaps with limited success. A chimeric anterolateral thigh (ALT) perforator-free flap with vastus lateralis (VL) muscle was used to obliterate the post-pneumonectomy intrathoracic dead space and to provide a cutaneous paddle. This case report aims to show the versatility of the ALT flap for chest wall reconstruction to prevent the post-pneumonectomy syndrome associated with tracheal deviation, inspiratory stridor, and exertional dyspnea. In conclusion, chest wall reconstruction with obliteration of intrathoracic dead space post-pneumonectomy is challenging and needs careful planning and execution.展开更多
目的:长时间漏气(prolonged air leak,PAL)是肺手术后最常见的术后并发症之一。这项研究旨在确定肺切除后PAL的风险因素,并构建一个术前预测模型,以估计其对单个患者的风险。方法:回顾性分析2017年01月至2021年06月期间接受解剖性肺切...目的:长时间漏气(prolonged air leak,PAL)是肺手术后最常见的术后并发症之一。这项研究旨在确定肺切除后PAL的风险因素,并构建一个术前预测模型,以估计其对单个患者的风险。方法:回顾性分析2017年01月至2021年06月期间接受解剖性肺切除的肺恶性肿瘤患者。PAL被定义为手术后7天以上的空气泄漏,并分析了风险因素。通过多因素Logistic回归模型,以识别独立的风险因素,并构建了列线图模型。采用重复抽样1000次的Bootstrap检验对列线图模型进行内部验证。采用一致性指数(concordance index,C-index)和校准曲线来表示模型的预测性能和预测准确度。决策曲线分析(decision curve analysis,DCA)评价该列线图模型的临床应用价值。结果:共有738名符合研究标准的患者纳入了这项研究。PAL的总体发病率为8.3%(61/738)。最终模型中包括身体质量指数(body mass index,BMI)、吸烟状况、手术时间、胸腔粘连和晚期肺癌炎症指数(advanced lung cancer inflammation index,ALI)。校准曲线表明该模型拟合较好;ROC曲线下面积(area under curve,AUC)为0.784(95%CI:0.720~0.848);DCA结果表明该模型具有较高的净获益水平。结论:本研究建立了列线图模型,对肺癌患者解剖性肺切除术后PAL的发生有较好的预测能力及良好的临床应用价值。展开更多
文摘Chest wall reconstruction is a surgical procedure aimed at restoring the integrity and function of the chest wall, which may be damaged due to trauma, cancer, infection, or congenital defects. The chest wall plays a vital role in protecting the thoracic organs, supporting the respiratory system, and maintaining the shape of the chest. Therefore, any defect or deformity of the chest wall can have significant functional and aesthetic consequences for the patient. The authors present a case report at Kenyatta National Hospital (KNH) of a dyspneic 47-year-old male patient with a right anterolateral chest wall defect post-pneumonectomy previously complicated by bronchopleural fistula. Past attempts at the chest wall reconstruction had utilized the ipsilateral latissimus dorsi muscle, pectoralis major muscle, and the omental pedicled flaps with limited success. A chimeric anterolateral thigh (ALT) perforator-free flap with vastus lateralis (VL) muscle was used to obliterate the post-pneumonectomy intrathoracic dead space and to provide a cutaneous paddle. This case report aims to show the versatility of the ALT flap for chest wall reconstruction to prevent the post-pneumonectomy syndrome associated with tracheal deviation, inspiratory stridor, and exertional dyspnea. In conclusion, chest wall reconstruction with obliteration of intrathoracic dead space post-pneumonectomy is challenging and needs careful planning and execution.
文摘目的:长时间漏气(prolonged air leak,PAL)是肺手术后最常见的术后并发症之一。这项研究旨在确定肺切除后PAL的风险因素,并构建一个术前预测模型,以估计其对单个患者的风险。方法:回顾性分析2017年01月至2021年06月期间接受解剖性肺切除的肺恶性肿瘤患者。PAL被定义为手术后7天以上的空气泄漏,并分析了风险因素。通过多因素Logistic回归模型,以识别独立的风险因素,并构建了列线图模型。采用重复抽样1000次的Bootstrap检验对列线图模型进行内部验证。采用一致性指数(concordance index,C-index)和校准曲线来表示模型的预测性能和预测准确度。决策曲线分析(decision curve analysis,DCA)评价该列线图模型的临床应用价值。结果:共有738名符合研究标准的患者纳入了这项研究。PAL的总体发病率为8.3%(61/738)。最终模型中包括身体质量指数(body mass index,BMI)、吸烟状况、手术时间、胸腔粘连和晚期肺癌炎症指数(advanced lung cancer inflammation index,ALI)。校准曲线表明该模型拟合较好;ROC曲线下面积(area under curve,AUC)为0.784(95%CI:0.720~0.848);DCA结果表明该模型具有较高的净获益水平。结论:本研究建立了列线图模型,对肺癌患者解剖性肺切除术后PAL的发生有较好的预测能力及良好的临床应用价值。
