Injongo:
Ukuvuselelwa komdanso we-Chest kuyadingeka uma kunesici endaweni ye-thoracic noma yesifuba. Isizathu esivame kakhulu seziphambeko zodonga lwesifuba yisilonda esinegciwane lesandulela ngculaza noma esingaqiniseki. Ukwehla komzimba okuphakathi komzimba kuyindlela yokuhlinzwa lapho kwenziwa khona ukushisa okuqondile phakathi kwe-sternum (eyaziwa nangokuthi i-breastbone), emva kwalokho i-sternum ihlukaniswe noma iqhekekile.
Le nqubo inikeza ukufinyelela kwenhliziyo namaphaphu ngezinqubo zokuhlinza.
I-Etiology:
Amaphutha omzimba wesibeletho ahlanganiswe abe yizigaba ezimbili ezijwayelekile: atholakale futhi azalwa .
Kutholakale:
- I-Trauma
- I-Tumor
- Ukutheleleka
- Umswakama
I-Congenital:
- I-Poland Syndrome
- I-Pectus Excavatum
- I-Pectus Carinatum
Imigomo:
Imigomo yokuvuselela yilezi:
- Susa izicubu ezingekho emzimbeni, ezenziwe ngokuzikhandla kusukela odongeni lwesifuba
- Buyisela ukuzinza nokuhlelwa kwindonga yesifuba
- Gwema noma yimuphi isikhala esifile (isikhala esiphelile yisikhala esingenalutho esibangela ngemuva kokukhipha ingxenye yamaphaphu noma lonke iphaphu)
- Nikeza ukugcina okuqinile kwendonga yesifuba
- Finyelela imiphumela yobuhle
Anatomy:
Udonga lwesifuba lunamaqhosha amathathu:
- Isendlalelo sangaphandle: Izicubu ezinomsoco, okuhlanganisa isikhumba, amafutha angaphansi kwesisu nomzimba
- Uhlaka oluphakathi: I-Skeleton, ehlanganisa izimbambo, i-cartilage, ne-sternum
- Isendlalelo sangaphakathi: Isikhala se-Pleural, isikhala (isikhala) esiphakathi kwamasipha namaphaphu
Okukodwa, kokubili, noma kuzo zonke izingxenye ezintathu kungase kudingeke kuvuselelwe kuye ngokungafani.
Ukulandelana okubuyiselwayo kuqala ngezicubu ezijulile futhi kuqhubekela phambili emgodini omkhulu, bese uhlaka lwesifuba, futhi ekugcineni izicubu ezithambile.
Ukwengeza, uhlobo lokwakha kabusha luzoxhomeka endaweni engafanele emdongeni wesifuba.
Ukuvuselelwa kabusha kwe-Inner Layer:
- Umgomo wokuvuselela ungqimba wangaphakathi, owaziwa nangokuthi umgodi we-parietal, ukuthola ukuthola isikhala esingaxhunywanga.
- Lokhu kwenziwa ngokugcwalisa isikhala esifile ukuze sigweme ukuthi sigcwaliswe nge-fluid kanye / noma i-pus.
- Isikhala esilalayo sigcwaliswa ngokusebenzisa iziphazamiso zomzimba (owaziwa nangokuthi i-locoregional flaps) esifundeni sephutha noma esebenzisa i- omentum :
- I-Latissimus dorsi flap
- I-Serratus i-flap yangaphakathi
- I-Pectoralis i-flap enkulu
- I-Rectus abdominis flap
- I-flap ye-Omental
Ukwakhiwa kabusha koMugqa Ophakathi:
- Isendlalelo samathambo kubhekwa njengengqimba engaphakathi
- Lokhu kubaluleka kuyadingeka ukuvikela izitho ezibalulekile (inhliziyo, amaphaphu, njll) nokukhiqiza ukuphefumula okuvamile
- Uma izimbambo ezine noma ngaphezulu zisusiwe noma isici singaphezu kwamamentimitha amahlanu, isendlalelo samathambo kumele sakhiwe kabusha
- Ukwakhiwa kabusha kwenziwa ngezinketho ezilandelayo:
Ukuvuselelwa kwe-alloplastic:
- Isikhonkwane siqiniswe nge-methyl methacrylate
- I-Bone grafts
Ukwakhiwa okuzenzakalelayo:
- I-Latissimus dorsi flap
- I-Serratus i-flap yangaphakathi
- I-Pectoralis i-flap enkulu
- I-Rectus abdominis flap
- I-flap ye-Omental
Ukwakhiwa kabusha kwe-Layout Outer:
- Izicubu ezithambile (isikhumba, izicubu zangaphansi) kubhekwa njengengqimba yangaphandle
- Isici samathambo athambile singaba ubukhulu obuyingxenye (isilonda esingenasici) noma kungaba ubukhulu obugcwele (isilonda esijulile)
Amanxeba ahlangene okuhlanganiswa avuselelwa nge:
- Ama- graft we-sclit -thickness
- Ama- flaps e- Locoregional
Amaphilisi okuqina okugcwele abuyiselwa kabusha nge:
- Ama-flaps e-Locoregional
- I-Flaps yamahhala ezimweni ezingavamile
Imithombo:
I-Din AM, i-Evans GRD. Ukwakhiwa kabusha kweKhotho lweKhotho. E-McCarthy JG, Galiano RD, iBoutros SG, ama-eds. Ukwelashwa Kwamanje Ngokwelashwa Kwepulasitiki. I-Philadelphia: Saunders Elsevier, 2006.
Janis JE. Ukwakhiwa kabusha kweKhotho lweKhotho. KuJanis JE (ed). Izinto ezibalulekile zokuhlinza nge-Plastic. USt. Louis: I-Quality Medical Publishing inc., 2007.
Chang RR. Ukuvuselelwa kweTraracic. In Thorne CHM, Beasely RW, Aston SJ, Bartlett SP, Gurtner GC, Spear S, ama-eds. Ukuhlinzwa Kwe-Plastic Grabb no-Smith, 6th. I-Philadelphia: Lippincott, 2007.
I-Pectus Carinatum Medline Plus.
Kufinyelelwe ngo-Ephreli 2, 2011.
I-Pomerantz J, i-Hoffman W. Chest Wall Defects. Kryger, ZB, Sisco M (eds.). Ukuhlinzwa Okusebenzayo Kwepulasitiki. Austin, Texas: Landes Bioscience, 2007.
http://www.microsurgeon.org/. Kufinyelelwe ngo-Ephreli 2, 2011.