Ahmet BİLEN, Dalokay KILIÇ, Alper FINDIKÇIOĞLU, Ahmet HATİPOĞLU

Toraks duvarı defektlerinin onarımında mersilen meş-metil metakrilat sandviç greft kullanımı ile rekonstrüksiyon

Toraks duvarı rezeksiyonları özellikle primer, metastatik toraks duvarı tümörleri ve akciğer kanserinin lokal yayılımı nedeniyle yapılmakta ve uygulanan rezeksiyonlardan sonra göğüs duvarında oluşan defekt çapı 5 cm’den geniş olmaktadır. Toraks duvarının ön ve yan tarafında oluşan bu büyük defektler göğüs stabilitesini bozmakta, paradoksal solunuma yol açmaktadır. Bu tip defektlerde, intratorasik organları dış etkenlerden koruyabilmek toraks duvarı stabilizasyonu ile fizyolojik solunumun devamını sağlamak için rekonstrüksiyon zorunlu olmaktadır. Mart 2003-Eylül 2005 tarihleri arasında değişik endikasyonlarla toraks duvarı rezeksiyonu yapılan ve rekonstrüksiyon için mersilen meş-metil metakrilat (MM-MM) sandviç greft kullanılan sekiz olgu incelendi. Rekonstrüksiyon için kullanılan MM-MM uygulama tekniği ve sonuçları anlatılarak diğer materyallerle karşılaştırılması yapıldı. Tüm hastalar ameliyattan sonraki erken dönemde ekstübe edildi. Hastanede postoperatif ortalama kalış süresi 9.6 (5-11 gün) gün idi. Hastalar ortalama 9 (3-34) ay takip edildi. Hastalarımızın hiçbirinde paradoks solunum gelişmedi. Operasyon sırasında ve erken postoperatif (ilk 30 gün) mortalite ve morbidite görülmedi. Sonuç olarak, rekonstrüksiyon gerektiren toraks duvarı defektlerinde; uygulama kolaylığı, biçim verilebilmesi, intratorasik organları koruyacabilecek sertlik ve dayanıklılıkta olması, infeksiyon riskinin az ve diğer materyallere göre çok daha ucuz olması nedeniyle MM-MM ile hazırlanan sandviç grefti önermekteyiz.

Mersilene mesh-methyl methacrylate sandwich graft reconstruction for repair of chest wall defects

The diameter of the defect after resection exceeds 5 cm especially in primary malignant and metastasis of chest wall tumors and bronchial carcinomas invading chest wall. Reconstruction must be performed in cases in which antero-lateral chest wall and sternum were resected in order to prevent paradoxical respiration caused by chest wall instability and to protect the vital organs from external effects. Eight cases undergoing chest wall resection for varying indications and reconstruction with methyl methacrylate-mersilene mesh (MM-MM) sandwich graft between March 2003 and September 2005 were reviewed. The reconstruction technique of MM-MM sandwich graft was compared with other reconstruction materials. Early and late postoperative mortality and morbidity ratios of the cases that MM-MM sandwich graft performed were compared with the other prosthetic materials in literature. All of the patients were extubated in the early postoperative period. There were no postoperative mortality and morbidity. Mean hospital stay was 9.6 days (range, 5-11 days). Mean follow-up was 9 (range, 3-34 months) months paradoxical respiration was no observed in whole patients during follow-up period. We recommend use of the MM-MM sandwich graft rather than the PTFE graft for large defects of the anterolateral chest wall and sternum for successful prevention of paradoxical respiration. Additionally, the MM-MM provides better cosmetic options, is inexpensive and easy to apply, and offers minimal morbidity.

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