Abstract：
BACKGROUND:The optimal strategy for oncologic sternectomy reconstruction has not been well characterized. We hypothesized that the major factors driving the reconstructive strategy for oncologic sternectomy include the need for skin replacement, extent of the bony sternectomy defect, and status of the internal mammary vessels. STUDY DESIGN:We reviewed consecutive oncologic sternectomy reconstructions performed at The University of Texas MD Anderson Cancer Center during a 10-year period. Regression models analyzed associations between patient, defect, and treatment factors and outcomes to identify patient and treatment selection criteria. We developed a generalized management algorithm based on these data. RESULTS:Forty-nine consecutive patients underwent oncologic sternectomy reconstruction (mean follow-up 18 ± 23 months). More sternectomies were partial (74%) rather than total/subtotal (26%). Most defects (n = 40 [82%]) required skeletal reconstruction. Pectoralis muscle flaps were most commonly used for sternectomies with intact overlying skin (64%) and infrequently used when a presternal skin defect was present (36%; p = 0.06). Free flaps were more often used for total/subtotal vs partial sternectomy defects (75% vs 25%, respectively; p = 0.02). Complication rates for total/subtotal sternectomy and partial sternectomy were equivalent (46% vs 44%, respectively; p = 0.92). CONCLUSIONS:Despite more extensive sternal resections, total/subtotal sternectomies resulted in equivalent postoperative complications when combined with the appropriate soft-tissue reconstruction. Good surgical and oncologic outcomes can be achieved with defect-characteristic-matched reconstructive strategies for these complex oncologic sternectomy resections.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Butterworth JA,Garvey PB,Baumann DP,Zhang H,Rice DC,Butler CEdoi
10.1016/j.jamcollsurg.2013.02.014subject
Has Abstractpub_date
2013-08-01 00:00:00pages
306-16issue
2eissn
1072-7515issn
1879-1190pii
S1072-7515(13)00159-2journal_volume
217pub_type
杂志文章abstract：BACKGROUND:Surgery remains the most effective intervention for obesity and its comorbidities. However, the long-term efficacy of bariatric procedures is rarely reported. This study addresses operative trends, efficiency, and long-term outcomes from a large bariatric program. STUDY DESIGN:Data were prospectively collec...
journal_title：Journal of the American College of Surgeons
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journal_title：Journal of the American College of Surgeons
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journal_title：Journal of the American College of Surgeons
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journal_title：Journal of the American College of Surgeons
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doi：10.1016/s1072-7515(98)00159-8
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