Pedicled Vertical Rectus Abdominis Musculocutaneous Flap Reconstruction in a Marfan's Syndrome Patient with Pectus Excavatum after Left Modified Radical Mastectomy and Bentall's Operation-A Case Report and Literature Review

垂直腹直肌皮瓣使用於一位有漏斗胸之馬凡氏症候群病患接受左側改良式根治性全乳房切除術以及帶主動脈瓣人工血管升主動脈替換手術後之胸壁缺損－病例報告及文獻回顧

鄭旭棠(Hsu-Tang Cheng) ； 吳肇毅(Chao-I Wu) ； 陳信翰(Hsin-Han Chen) ； 許永昌(Erh-Kang Chou) ； 周爾康(Yung-Chang Hsu) ； 張家寧(Chia-Ning Chang)

《臺灣整形外科醫學會雜誌》 19卷1期 (2010/03) Pp. 78-84

https://doi.org/10.7096/TJTSPS.201003.0078

摘要

背景：
漏斗胸是馬凡氏症候群的病患常見的胸壁變異，比例超過六成。而主動脈剝離則是這類病患最致命的併發症。手術過程通常需要相當長的時間以及大範圍的術野。嚴重的漏斗胸將使得心臟血管外科醫師難以採行傳統的開胸手術。有時候，必須同時在作心臟手術時，矯正病患漏斗胸的問題。
目的及目標：
探討心臟外科手術合併漏斗胸之矯正之可行性，以及垂直腹直肌皮瓣於胸壁缺損之應用。
材料及方法：
我們在此提出我們臨床上合併心臟外科手術，矯正一位馬凡氏症候群病患之漏斗胸。之後，並使用垂直腹直肌皮瓣重建手術後之胸壁缺損。
結果：
病患術後恢復良好，胸壁畸形亦獲得矯正。
結論：
臨床上可以採行心臟外科手術合併漏斗胸之矯正，而其術後之胸壁缺損可以使用垂直腹直肌皮瓣重建。

並列摘要

Background:
Pectus excavatum is the most common chest deformity among patients with Marfan's syndrome with an incidence more than 60 percent. Severe cardiovascular disorders, including aortic dissection, are the main life-threatening complications of Marfan's syndrome. Long operation time and well-exposed operation field may risk these patients. Severe pectus excavatum can make the intraoperative cardiovascular approach even more complicated. Sometimes pectus excavatum and cardiac problems require simultaneous surgeries.
Aim and Objectives:
The purpose of this article is to investigate the clinical feasibility of simultaneous open-heart surgery and pectus deformity correction and application of pedicled vertical rectus abdominis musculocutanesous (VRAM) flap in chest wall defect.
Materials and Methods:
We present our clinical experience of combined severe pectus excavatum correction and aortic root replacement in a Marfan's syndrome patient who previously received modified radical mastectomy. The resulting chest wall deformity was reconstructed with pedicled VRAM flap.
Results:
The patient recovered well from the cardiac and pectus correction surgeries. The pedicled VRAM flap successfully reconstructed the chest wall defect.
Conclusion:
It is feasible to perform simultaneous open-heart surgery and pectus deformity correction. The resulting chest wall defect can be reconstructed with pedicled VRAM flap.

並列關鍵字

pedicled vertical rectus abdominis musculocutanesous flap ； pectus excavatum ； open-heart surgery ； Marfan's syndrome