広背筋皮弁による胸壁・縦隔再建

Chest Wall and Mediastinal Reconstructions Using a Latissimus Dorsi Flap: Indications, Surgical Techniques, and Pitfalls

はじめに

　縦隔炎や胸部悪性腫瘍切除後の胸壁欠損は，感染制御や軟部組織の確実な被覆，または術後治療への早期移行を考慮しながら適切な再建を行う必要がある。有茎広背筋皮弁による再建術は血流が安定しており可動域も広く，多様な欠損に対応できる優れた選択肢である。

　本稿では適応，デザイン，手技，注意点を症例を交え概説する。

　In cases of mediastinitis that occur after cardiovascular surgery and those of chest-wall defects that are associated with malignant tumor resection, stable reconstruction is required in order to achieve infection control and allow prompt oncologic treatment. The pedicled latissimus dorsi flap provides a useful option for various chest wall reconstructions; it also offers relatively reliable perfusion. We describe the indications, preoperative design, surgical techniques, management of the vascular pedicle, and pitfalls of using the pedicled latissimus dorsi flap, based on cases involving mediastinitis, prosthetic graft infection, and chest-wall malignancy resection. Thorough preoperative planning and appropriate surgical techniques are essential for successful reconstructions involving a pedicled latissimus dorsi flap.