In thoracic surgery, the majority of defects requiring reconstruction results from tumor resections. The reconstruction techniques can be differentiated mainly in rigid and non- rigid ones, according to the material used. We aimed to evaluate the kinematics of the chest wall preoperatively and during postoperatively follow up in patients that underwent reconstruction of different parts of the chest wall using a new rigid technique called the Rib-Like Reconstruction technique(RLR) compared with a non-rigid standard technique(CTR). We studied 7 RLR and 2 CTR patients at baseline before surgery and after 40 days, 3 and 6 months. Spirometry, maximal pressures at the mouth and chest wall kinematics assessed by Opto-Electronic Plethysmography in seated and supine position during quiet breathing and forced vital capacity were measured at every visit. Moreover, 3 patients after ThoracoPleuroPneumonectomy(TPP) were acquired one year after surgery and compared with 3 healthy women. The results show that after surgery spirometry and maximum respiratory pressures tend to reduce. During quiet breathing, the rib cage expansion in RLR was more or less maintained around its baseline values, particularly in the treated part, in both positions; while the treated rib cage volume variation in CTR not only decreased but it also showed negative value, index of paradoxical inspiratory inward movement. This behavior was even worse during the forced maneuver. On the other hand, the TPP patients were characterized by a ventilatory pattern at rest comparable with healthy women with no paradoxical movement of the reconstructed part even during forced vital capacity. In conclusion, the rib-like prosthesis seems to be stiff enough to avoid inward paradoxical movement during inspiration, but well compliant to expand and guarantee a normal ventilatory pattern with no ribcage distortion, both for partial or total reconstruction of the hemithorax. On the other hand, the mesh reconstruction seems to introduce an important factor of ribcage distortion resulting in paradoxical movement leading to possible atelectasis of the lung.
In chirurgia toracica la maggior parte dei casi che richiedono ricostruzione deriva da resezione di tumori. Le tipologie di ricostruzione possono essere divise in rigide e non rigide a seconda del materiale utilizzato. Il nostro scopo è stato valutare la cinematica della parete toracica prima dell’operazione chirurgica e dopo, in una serie di visite periodiche, in pazienti che si sono sottoposti a ricostruzione di diverse parti di parete toracica utilizzando una nuova tecnica di ricostruzione rigida denominata rib-like reconstruction technique (RLR) confrontata con una tecnica standard non rigida (CTR). Sono stati valutati 7 pazienti RLR e 2 pazienti CTR prima dell’operazione, dopo 40 giorni, 3 mesi e 6 mesi. Sono state misurate ad ogni visita le spirometrie, le pressioni massime alla bocca e la cinematica della parete toracica tramite Pletismografia Optoelettronica in posizione seduta e supina durante sia respiro tranquillo sia manovre di capacità vitale forzata. Inoltre, ad un anno di distanza dall’operazione, sono stati acquisiti 3 pazienti che hanno subito toracopleuropneumonectomia(TPP) e sono stati confrontati con un gruppo di 3 donne sane. I risultati mostrano come dopo l’operazione spirometrie e massime pressioni alla bocca tendono a diminuire. Durante respiro tranquillo l’espansione della rib cage nel gruppo RLR è stata più o meno mantenuta attorno ai valori preoperatori, in particolare nella parte trattata, in entrambe le posizioni; invece nel gruppo CTR la variazione di volume della rib cage trattata non solo tendeva a scendere ma mostrava anche un valore negativo, indice di movimento inspiratorio di rientro paradosso. Questo comportamento peggiorava durante la manovra forzata. Il gruppo TPP, invece, è stato caratterizzato da un pattern ventilatorio a riposo comfrontabile con il gruppo di donne sane, senza movimento paradosso della parte ricostruita anche durante la manovra di capacità vitale forzata. In conclusione, la protesi rib-like sembra essere sufficientemente rigida da evitare movimenti di rientro paradosso durante inspirazione, ma abbastanza compliante da poter espandersi e garantire un pattern ventilatorio normale senza distorsione della gabbia toracica, sia per ricostruzioni parziali che totali dell’emitorace. Le ricotruzioni che utilizzano mesh, invece, sembrano introdurre un importante fattore di distorsione della gabbia toracica risultante in un movimento paradosso che potrebbe portare ad atelectasie del polmone.
Short term follow up of chest wall kinematics after rib-like reconstruction technique
CAPSONI, VALERIA
2013/2014
Abstract
In thoracic surgery, the majority of defects requiring reconstruction results from tumor resections. The reconstruction techniques can be differentiated mainly in rigid and non- rigid ones, according to the material used. We aimed to evaluate the kinematics of the chest wall preoperatively and during postoperatively follow up in patients that underwent reconstruction of different parts of the chest wall using a new rigid technique called the Rib-Like Reconstruction technique(RLR) compared with a non-rigid standard technique(CTR). We studied 7 RLR and 2 CTR patients at baseline before surgery and after 40 days, 3 and 6 months. Spirometry, maximal pressures at the mouth and chest wall kinematics assessed by Opto-Electronic Plethysmography in seated and supine position during quiet breathing and forced vital capacity were measured at every visit. Moreover, 3 patients after ThoracoPleuroPneumonectomy(TPP) were acquired one year after surgery and compared with 3 healthy women. The results show that after surgery spirometry and maximum respiratory pressures tend to reduce. During quiet breathing, the rib cage expansion in RLR was more or less maintained around its baseline values, particularly in the treated part, in both positions; while the treated rib cage volume variation in CTR not only decreased but it also showed negative value, index of paradoxical inspiratory inward movement. This behavior was even worse during the forced maneuver. On the other hand, the TPP patients were characterized by a ventilatory pattern at rest comparable with healthy women with no paradoxical movement of the reconstructed part even during forced vital capacity. In conclusion, the rib-like prosthesis seems to be stiff enough to avoid inward paradoxical movement during inspiration, but well compliant to expand and guarantee a normal ventilatory pattern with no ribcage distortion, both for partial or total reconstruction of the hemithorax. On the other hand, the mesh reconstruction seems to introduce an important factor of ribcage distortion resulting in paradoxical movement leading to possible atelectasis of the lung.File | Dimensione | Formato | |
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https://hdl.handle.net/10589/96466