Malign göğüs duvarı tümörlerinin rezeksiyonu sonrası titanyum plak ve prolen meş ile rekonstrüksiyonun etkinliği

Amaç: Malign göğüs duvarı tümörlerinin rezeksiyonu sonrası oluşan defekti kapatmak için birçok rekonstrüksiyon yöntemi bildirilmiştir. Bu çalışmada amacımız rezeksiyon sonrası titanyum plak ve prolen meş ile uyguladığımız rekonstrüksiyon metodunun klinik etkinliğini ortaya koymaktır. Gereç ve Yöntemler: 2010 Ocak ile 2019 Aralık arası malign göğüs duvarı tümörü tanısı ile göğüs duvarı rezeksiyonu uygulanan 11 hastaya, oluşan defekti kapatmak için titanyum plak ve prolen meş kullanıldı. Tanı 4 hastada kondrosarkoma, 3 hastada memenin duktal karsinomunun metastazı, 2 hastada ewing sarkomu, 1 hastada küçük hücreli dışı akciğer karsinomunun göğüs duvarı invazyonu, 1 hastada soliter plazmositoma idi. Tüm hastalarda tümör ile birlikte 2-4 cm normal doku, bir alt ve bir üst kaburga içeren rezeksiyon uygulandı. Peroperatif cerrahi sınırlar frozen çalışılarak negatif olduğu gösterildi. Bulgular: Hastaların 7’si (%63) erkek, 4’ü (%36) bayan, ortalama yaş 62±3.4 idi. Kaburga rezeksiyonu dışında 2 hastada parsiyel sternum, 1 hastada akciğer ve 1 hastada diyafragma rezeksiyonu uygulandı. Üç hastada titanyum plak ve prolen meş uygulamasına ilave olarak yumuşak doku rekonstrüksiyonu uygulandı. Hastaların 4’ünde postoperatif komplikasyon görüldü. İki hastada yara yeri enfeksiyonu, 1 hastada pnömoni, diğer 1 hastada atelektazi gelişti. Yoğun bakım yatış süresi 1.83±1.13 (2-5), hastanede yatış süresi 6.34±2.13 (5-16) idi. Hastalar ortalama 23±4.5 (12-38) ay takip edildi. Takipte 1 hastada lokal rekürrens saptandı. Sonuç: Malign göğüs duvarı tümörlerinde lokal rekürrensi önlemek amaçlı rezeksiyon sonrası 4 yönden frozen gönderilmelidir. Göğüs duvarının rekonstrüksiyonu için Titanyum plak ve prolen meş kombinasyonu morbiditesi ve enfeksiyon riski düşük, etkin ve kolay bir yöntemdir.

Anahtar Kelimeler:

Göğüs duvarı rezeksiyonu, titanyum plak, prolen meş, etkinlik

Effectiveness of reconstruction with titanium plate and prolene mesh after resection of malignant chest wall tumors

Aim: Many reconstruction methods have been reported to close the defect after resection of malignant chest wall tumors. The aim of this work is to evaluate the clinical effectiveness of the reconstruction method we applied with titanium plate and prolene mesh after resection. Materials and Methods: Titanium plate and prolene mesh were used to close the defect in 11 patients who underwent chest wall resection with the diagnosis of malignant chest wall tumor between January 2010 and December 2019. The diagnosis was chondrosarcoma in 4, metastasis of ductal carcinoma of the breast in 3, ewing sarcoma in 2, chest wall invasion of non-small cell lung carcinoma in 1, and solitary plasmacytoma in 1 patient. Resection including 2-4 cm normal tissue, lower and upper ribs was performed with tumor in all patients. Perioperative surgical limits were shown to be negative by studying frozen. Results: There were 7 males (63%) and 4 females (36%) with a mean age of 62±3.4 years. Apart from rib resection, 2 had partial sternum, 1 had lung and 1 patient had diaphragmatic resection. In 3 patients, soft tissue reconstruction was applied in addition to titanium plate and prolene mesh application. Postoperative complications were seen in 4 of the patients. Wound infection occurred in 2 patients, pneumonia in 1 patient, and atelectasis in another patient. The intensive care hospital stay was 1.83±1.13 (2-5), and the hospital stay was 6.34±2.13 (5-16). The patients were followed up for an average of 23±4.5 (12-38) months. Local recurrence was detected in 1 patient during follow-up. Conclusion: In order to prevent local recurrence in malignant chest wall tumors, frozen should be sent in 4 directions after resection. Titanium plate and prolene mesh combination is an effective and easy method with low morbidity and infection for the reconstruction of the chest wall.

Keywords:

Resection of chest wall , Titanyum plate, prolene mesh, effectiveness,

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