• Journal of Trauma and Injury
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• 제34권4호
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• pp.284-287
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• 2021

We report a case of delayed chest wall reconstruction after thoracotomy. A 53-yearold female, a victim of a motor vehicle accident, presented with bilateral multiple rib fractures with flail motion and multiple extrathoracic injuries. Whole-body computed tomography revealed multiple fractures of the bilateral ribs, clavicle, and scapula, and bilateral hemopneumothorax with severe lung contusions. Active hemorrhage was also found in the anterior pelvis, which was treated by angioembolization. The patient was transferred to the surgical intensive care unit for follow-up. We planned to perform surgical stabilization of rib fractures (SSRF) because her lung condition did not seem favorable for general anesthesia. Within a few hours, however, massive hemorrhage (presumably due to coagulopathy) drained through the thoracic drainage catheter. We performed an exploratory thoracotomy in the operating room. We initially planned to perform exploratory thoracotomy and "on the way out" SSRF. In the operating room, the hemorrhage was controlled; however, her condition deteriorated and SSRF could not be completed. SSRF was completed after about a month owing to other medical conditions, and the patient was weaned successfully.

• Journal of Chest Surgery
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• 제52권5호
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• pp.360-367
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• 2019

Background: Primary chest wall sarcoma is a rare disease with limited reports of surgical resection. Methods: This retrospective review included 41 patients with primary chest wall sarcoma who underwent chest wall resection and reconstruction from 2001 to 2015. The clinical, histologic, and surgical variables were collected and analyzed by univariate and multivariate Cox regression analyses for overall survival (OS) and recurrence-free survival (RFS). Results: The OS rates at 5 and 10 years were 73% and 61%, respectively. The RFS rate at 10 years was 57.1%. Multivariate Cox regression analysis revealed old age (hazard ratio [HR], 5.16; 95% confidence interval [CI], 1.71-15.48) as a significant risk factor for death. A surgical resection margin distance of less than 1.5 cm (HR, 15.759; 95% CI, 1.78-139.46) and histologic grade III (HR, 28.36; 95% CI, 2.76-290.87) were independent risk factors for recurrence. Conclusion: Long-term OS and RFS after the surgical resection of primary chest wall sarcoma were clinically acceptable.

• Archives of Plastic Surgery
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• 제37권5호
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• pp.589-594
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• 2010

Purpose: Full thickness skin grafts are useful in the reconstruction of facial skin defects when primary closure is not feasible. Although the supraclavicular area has been considered as the choice of donor site for large facial skin defect, many patients are reluctant to get a neck scar and some patients do not have enough skin to cover the defect owing to the same insult occurred to the neck such as burn accident. We present several cases of reconstruction of facial skin defects by freehand full-thickness skin graft from anterolateral chest wall resulting aesthetically acceptable outcome with lesser donor site morbidity. Methods: Retrospective review was performed from March, 2007 to September, 2009. 15 patients were treated by this method. Mean age was 31.5 years. The ethiology was congenital melanocytic nevus in 7 cases, capillary malformation in 5 cases and burn scar contracture in 3 cases. Mean area of lesion was measured to 67.3 cm2 preoperatively. The lesion was removed beneath the subcutaneous fatty tissue layer. The graft was not trimmed to be thin except defatting procedure. For the larger size of defect, two pieces of grafts were harvested from both anterolateral chest wall in separation and combined by suture. Results: The mean follow up period was 9.7 months. All the grafts survived without any problem except small necrotic areas in 4 cases, which healed spontaneously under conventional dressings in 6 weeks postoperatively. Color match was relatively excellent. There were 2 cases of hyperpigmentation immediately, but all of them disappeared in a few months. Conclusion: In cases of large facial skin defects, the anterolateral chest wall may be a good alternative choice of full-thickness skin graft.

• Archives of Plastic Surgery
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• 제36권4호
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• pp.503-506
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• 2009

Purpose: Unilateral breast reconstruction after mastectomy confront the challenges of recreating a natural appearing breast mound and achieving symmetricalness of the breasts. If the patient's remaining breast is large compared to reconstructed breast, the most common procedure is reduction mammoplasty of the large breast side. The authors experienced a new method of breast reconstruction using the excess breast tissue from the contralateral breast after breast reduction. Methods: The excess tissue from the contralateral breast after vertical reduction mammoplasty with superior pedicle and remaining lower breast tissue were transferred to the mastectomy site breast through the subcutaneous tunnel on the chest wall. The main blood supplies of the flap are perforator branches of the 4th, 5th and 6th anterior intercostal artery. After elevating and detaching the flap on the lower lateral area of the breast, the turn overed flap is fixed on the upper portion of the chest wall of the mastectomy site. Results: On two cases of the breast reconstructions, remaining excess breast tissue from reduction mammoplasty was transferred to the contralateral breast side as pedicles. Both patient and operator were satisfied with the outcome of the reconstruction as the breasts were symmetrical and natural shape. Conclusion: We have performed unilateral breast reconstruction using the excess breast tissue after reduction mammoplasty of the contralateral breast. As Oriental women's breasts are relatively smaller than that of Caucasian women, delayed breast reconstruction cases of Oriental women with large breasts(macromastia) seem to be ideal for this procedure.

• Journal of Chest Surgery
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• 제27권1호
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• pp.68-71
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• 1994

A tracheo-esophageal fistula following from blunt chest trauma is one of less common lesion and few guidelines are available to direct its optimal management. Herein, we report a 24-year-old man injured in a motor vehicular accident sustained a nonpenetrating double blowout injury of the thorax and large tracheoesophageal fistula occurred. Tracheal defect required resection and reconstruction, of which the membranous portion underwent closure with borrowed adjacent esophageal wall primarily and substernal left colon interposition was performed 4 weeks later.

• Journal of Chest Surgery
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• 제29권1호
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• pp.115-119
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• 1996

방사선 치료 후 발생한 악성 섬유성 조직구종은 아주 드물며 일반적으로 예후가 나쁘다. 52세 남자환자가 6개월 전부터 발견된 흉골부위에 발생한 동통성의 종괴을 주소로 입원하였다. 환자는 5년전 식도암으로 방사선 치료를 받은 병력이 있었다. 종괴는 절개생검상 흥골육종으로 진단되어 항암약물요법을 5회 시행하였으나, 종괴가 점점 커져 수술을 시행하였다. 수술은 흥골을 덮고있는 피부와 늑연골을 포함하여 흥골 전절제술을 시행하였고 이로 인한 결손부위는 자가늑골 이식, 양측 대흥근 근육판과 피부이식으로 흥벽재건술을 시행하였다. 수술후 조직소견은 악성 섬유성 조직구종에 일치하였다. 수술후 경과는 순조로왔으며 36일째에 퇴원하였다.

• 대한두개안면성형외과학회지
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• 제10권2호
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• pp.109-113
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• 2009

Purpose: Materials for ear reconstruction are autogeneous cartilage and artificial implants. Despite their potential for donor site complications, autogeneous cartilage frameworks remain the accepted standard for external ear reconstruction. The purposes of this study were to investigate our ear reconstruction cases for 12 years. Methods: During twelve years from January 1996 to December 2008, 70 patients visited our hospital for ear reconstruction of microtia. Among them, 65 cases used autogenous cartilage frameworks, 3 cases used tissue expander and 2 cases used artificial implants. We investigated sex & age, common site, combined malformation, operation methods & their complications, donor site & their complications, anterior chest wall deformity and aesthetic evaluation. Results: Males were affected more often than females. Male to female ratio was 1.8 : 1. The common site of microtia was right ear (72%). And hemifacial microsomia was the most common associated congenital malformation. Surgical techniques included Tanzer-Ruecker method, Tissue-expander and Artificial framework ($Medpore^{(R)}$). Incidence of complication was higher with Tissue-expander & artificial framework than with Tanzer-Ruecker method. But There are few reports of using Tissue-expander & artificial framework and there was no acceptable statistical difference. And costal cartilage was harvested in ipsilateral side and anterior chest wall deformity reported only 2 cases under 10 year-old patients. Other minor complications reported such as, wound disruption and chest wall scar, but without any serious complications. Aesthetic result was evaluated by surgeons and patients for postoperative satisfaction and clinical evaluation. Conclusion: In ear reconstruction of microtia patient, delicate surgical strategy is important for natural shape and maintenance of postoperative contour. However, many methods were introduced for reconstrucion of microtia, the authors reconstructed an auricle in Tanzer-Ruecker method, Tissue-expander and Artificial famework ($Medpore^{(R)}$) for 70 patients. In our study, we generally chose Tanzer-Ruecker method and this treatment modality was satisfactory for patients and the postoperative result was acceptable for surgeons.

• Journal of Chest Surgery
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• 제7권1호
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• pp.67-72
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• 1974

This is a case report of total sternal resection and successful reconstruction of the sternum applying Tantalum plate in multiple myeloma. The patient was a 57 year old male with a tumor located on the middle sternum invading the manubrium and the body of the sternum developing symptoms after a contusion of the anterior sternum. The sternum resected with left and right. from first to sixth costochondral cartilages, and then Tantalum plate was fixed to the all fragments of the ribs with wire sutures. After reconstruction of the sternum applying Tantalum plate, the patient has had good breathing movements of the chest wall and also maintenance of respiratory function was satisfactory. Histopathologically, the tumor was consisted of a tissue of plasma cells, which was identical to multiple myeloma. Postoperative chemotherapy with Endoxan for multiple myeloma was administered. No recurrent symptoms of multiple myeloma could be observed during one year follow up period.

• Journal of Chest Surgery
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• 제31권6호
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• pp.629-633
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• 1998

폐암의 정확한 진단을 위한 세침 흡입생검에 의한 종양세포의 흉벽전이는 매우 희귀하나 생길 수 있는 합병증 중의 하나이다. 특히 세침 흡입생검에 의한 종양세포의 흉벽전이는 수술적 치료로 완치 가능성이 높은 폐암을 치료가 어려운 치명적인 상태로 전환시킬 수가 있다. 저자등은 세침 흡입생검 후 발생한 폐암의 흉벽전이 2예를 경험하였기에 보고하는 바이다. 55세 남자 환자는 전이된 흉벽의 늑골을 포함하여 전층을 절제하고 결손부위를 광배근을 이용한 근육피부판으로 흉벽 재건술을 시행하였으며 68세 여자 환자는 전이된 흉벽종양의 감염과 괴사성 출혈로 인해 흉벽의 부분절제와 피부이식으로 치료하였다. 두 환자 모두 각각 수술후 2년 7개월, 3개월까지 경과 양호하며 외래 추적관찰중이다.

• Investigative Magnetic Resonance Imaging
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• 제26권1호
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• pp.76-81
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• 2022

The number of women undergoing breast augmentation surgery with a prosthesis for cosmetic purposes or reconstruction after a mastectomy is steadily increasing. Hematoma is one of complications associated with breast augmentation surgery. It usually occurs early in the postoperative period. It rarely occurs late (after six months). However, chronic hematomas after prosthesis removal have not yet been reported in the radiological literature. We present a case of unilateral chronic organizing hematoma that developed late and grew persistently over long period after breast explantation, mimicking a soft tissue tumor of the chest wall clinically. Meanwhile, characteristic magnetic resonance imaging features of heterogeneous signal intensities on T1-weighted and T2-weighted images and dark signal intensity with a persistent enhancement of the peripheral wall of the lesion were found. These can be used for a differential diagnosis.