Göğüs Duvarı Tümörleri ve Rekonstrüksiyonu
Özet
Göğüs duvarı tümörleri; primer, komşu organlardan invaze veya metastatik lezyonları kapsayan heterojen bir gruptur. Primer tümörler tüm toraks neoplazmlarının %5'ini oluştururken, malignite oranı sternum ve skapula gibi bölgelerde oldukça yüksektir. En sık rastlanan primer malign kemik tümörü kondrosarkom, benign kemik lezyonu ise osteokondrom ve fibröz displazidir. Tanıda bilgisayarlı tomografi ve MRG gibi radyolojik yöntemlerin yanı sıra kalın iğne veya insizyonel biyopsiler kritik öneme sahiptir. Cerrahi rezeksiyon tedavinin temelini oluşturur; düşük dereceli malignitelerde 2 cm, yüksek derecelilerde ise 4 cm cerrahi sınır önerilir. Rezeksiyon sonrası oluşan geniş defektlerin rekonstrüksiyonunda göğüs kafesi stabilitesini sağlamak, akciğer herniasyonunu önlemek ve hayati organları korumak esastır. Bu amaçla sentetik/biyolojik meshler, metilmetakrilat sandviç greftler ve titanyum plak sistemleri gibi rijit materyaller kullanılır. Yumuşak doku kapamalarında latissimus dorsi ve pektoralis majör gibi lokal adale flepleri veya serbest doku transferleri tercih edilir. Başarılı bir yönetim için patoloji, plastik cerrahi ve göğüs cerrahisini içeren multidisipliner bir yaklaşım şarttır.
Chest wall tumors represent a heterogeneous group encompassing primary, locally invasive, or metastatic lesions. While primary tumors account for 5% of all thoracic neoplasms, malignancy rates are highly elevated in areas like the sternum and scapula. Chondrosarcoma is the most common primary malignant bone tumor, whereas osteochondroma and fibrous dysplasia are the most frequent benign bone lesions. Radiological methods such as CT and MRI, along with core needle or incisional biopsies, are critical for diagnosis. Surgical resection is the cornerstone of treatment; a 2 cm surgical margin is recommended for low-grade malignancies, while a 4 cm margin is required for high-grade ones. Reconstructing large defects after resection is essential to restore chest wall stability, prevent lung herniation, and protect vital organs. Rigid materials like synthetic/biological meshes, methyl methacrylate sandwich grafts, and titanium plate systems are utilized for this purpose. For soft tissue coverage, local muscle flaps such as latissimus dorsi and pectoralis major, or free tissue transfers, are preferred. A multidisciplinary approach involving pathology, plastic surgery, and thoracic surgery is mandatory for successful management.
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