Dataset Information

Thoracic Wall Reconstruction in Advanced Breast Tumours.

ABSTRACT: In advanced mammary tumours, extensive resections, sometimes involving sections of the thoracic wall, are often necessary. Plastic surgery reconstruction procedures offer sufficient opportunities to cover even large thoracic wall defects. Pedicled flaps from the torso but also free flap-plasties enable, through secure defect closure, the removal of large, ulcerated, painful or bleeding tumours with moderate donor site morbidity. The impact of thoracic wall resection on the respiratory mechanism can be easily compensated for and patients' quality of life in the palliative stage of disease can often be improved.

SUBMITTER: Daigeler A

PROVIDER: S-EPMC4069213 | biostudies-literature | 2014 Jun

REPOSITORIES: biostudies-literature

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Thoracic Wall Reconstruction in Advanced Breast Tumours.

Daigeler A A Harati K K Goertz O O Hirsch T T Behr B B Lehnhardt M M Kolbenschlag J J

Geburtshilfe und Frauenheilkunde 20140601 6

In advanced mammary tumours, extensive resections, sometimes involving sections of the thoracic wall, are often necessary. Plastic surgery reconstruction procedures offer sufficient opportunities to cover even large thoracic wall defects. Pedicled flaps from the torso but also free flap-plasties enable, through secure defect closure, the removal of large, ulcerated, painful or bleeding tumours with moderate donor site morbidity. The impact of thoracic wall resection on the respiratory mechanism ...[more]

PMID: 24976636

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Project description:BACKGROUND:Surgery remains the main curative option for the treatment of intraspinal tumour. The purpose of the present study was to analyze the clinical outcomes of laminoplasty with process-lamina complex replantation compared with laminectomy with pedicle screw fixation for intraspinal tumours. METHODS:In our retrospective analysis, 27 patients received tumour resection surgery by laminoplasty with reconstruction plate fixation and 32 patients received laminectomy with pedicle screw fixation. All patients were followed up for at least 1?year. Data, including surgical time, blood loss, volume of drainage, drainage time, hospital stay, complications, and neurological status were compared. In addition, imaging evaluation was also included. RESULTS:Patients in the laminoplasty group had lower blood loss (laminoplasty group: 281.5?±?130.2?mL; laminectomy group: 450.0?±?224.3?mL; p =?0.001), shorter surgical time (laminoplasty group: 141.7?± 26.2?min, laminectomy group: 175.3?± 50.4?min; p =?0.003), lower volume of drainage (laminoplasty group: 1578.9?±?821.7?mL, laminectomy group: 2621.2?±?1351.0?mL; p =?0.001), shorter drainage time (laminoplasty group: 6.6?±?2.5?days, laminectomy group: 9.7?±?1.8?days; p =?0.000), and a shorter hospital stay (laminoplasty group: 16.9?±?4.9?days, laminectomy group: 21.0?±?4.4?days; p =?0.002) compared with patients in the laminectomy group. There were significant differences of oswestry dysfunction index (ODI) between the two groups at 12?months postoperatively (p =?0.034). The incidence of secondary spinal stenosis in the laminoplasty group was significantly reduced (p =?0.029). CONCLUSIONS:Laminoplasty in intraspinal tumour resection has a lower blood loss and volume of drainage, shorter surgical time and hospital stay as advantages over the standard laminectomy technique. Moreover, laminoplasty can effectively avoid iatrogenic spinal canal stenosis and thus enhancing functional recovery of spinal cord.

Project description:Midline defects account for approximately 5% of congenital abnormalities observed at birth. However, the molecular mechanisms underlying the formation of the ventral body wall are not well understood. Recent studies linked mutations in Porcupine-an O-acetyl transferase mediating Wnt ligand acylation-with defects in the thoracic body wall. We hypothesized that anomalous Wnt signaling is involved in the pathogenesis of defective closure of the thoracic body wall. We generated a mouse model wherein Wntless (Wls), which encodes a cargo receptor mediating secretion of Wnt ligands, was conditionally deleted from the developing mesenchyme using Dermo1Cre mice. Wls(f/f);Dermo1(Cre/+) embryos died during mid-gestation. At E13.5, skeletal defects were observed in the forelimbs, jaw, and rib cage. At E14.5, midline defects in the thoracic body wall began to emerge: the sternum failed to fuse and the heart protruded through the body wall at the midline (ectopia cordis). To determine the molecular mechanism underlying the phenotype observed in Wls(f/f);Dermo1(Cre/+) embryos, we tested whether Wnt/?-catenin signaling was operative in developing the embryonic ventral body wall using Axin2(LacZ) and BatGal reporter mice. While Wnt/?-catenin signaling activity was observed at the midline of the ventral body wall before sternal fusion, this pattern of activity was altered and scattered throughout the body wall after mesenchymal deletion of Wls. Mesenchymal cell migration was disrupted in Wls(f/f);Dermo1(Cre/+) thoracic body wall partially due to anomalous ?-catenin independent Wnt signaling as determined by in vitro assays. Deletion of Lrp5 and Lrp6 receptors, which mediate Wnt/?-catenin signaling in the mesenchyme, partially recapitulated the phenotype observed in the chest midline of Wls(f/f);Dermo1(Cre/+) embryos supporting a role for Wnt/?-catenin signaling activity in the normal formation of the ventral body wall mesenchyme. We conclude that Wls-mediated secretion of Wnt ligands from the developing ventral body wall mesenchyme plays a critical role in fusion of the sternum and closure of the secondary body wall. Thus, impaired Wls activity in the ventral body wall mesenchyme is a mechanism underlying ectopia cordis and unfused sternum.

Dataset Information

Thoracic Wall Reconstruction in Advanced Breast Tumours.

Publications

Thoracic Wall Reconstruction in Advanced Breast Tumours.

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