Introduction The reconstruction of defects in thoracic wall remains a challenge for plastic surgeons. Advances in surgical treatment of illnesses of thoracic wall have been fostering the treatment of lesions within more advanced levels. Consequently, larger and more complex defects are generated, demanding soft tissue covering and framework repair. Objective The aim of this study was to report the experience in chest wall reconstruction and demographics of a tertiary cancer center. Methods All patients submitted to thoracic wall reconstruction by the plastic surgery department from January 2012 to May 2018 in a tertiary cancer center were evaluated. Results Thirty-two patients have undergone thoracic wall reconstruction. The majority of patients in our series were submitted to surgical treatment of locally advanced breast cancer (84.3%). The most common defect location was the right anterolateral region (65.6%). The latissimus dorsi musculocutaneous flap was the most used in thoracic wall reconstructions. Three cases of thoracectomy with rib resection were reconstructed with methylmethacrylate and polypropylene surgical mesh associated with musculocutaneous flap. Four patients presented major complications, and 12 patients (37.5%) presented minor complications. There were no deaths related to procedures or instability of thoracic wall. Twenty-two patients presented progression of the disease, and 16 died due to the primary pathology. Conclusions Extended resection of the chest wall is associated in most cases with advanced disease, especially advanced breast cancer. Despite poor prognosis associated to locally advanced disease, it is imperative to perform chest wall reconstruction and allow the patient to continue adjuvant therapy (radiotherapy or chemotherapy) and improve quality of life.
Introduction: Zygomycosis is a serious fungal infection of opportunistic character, affecting mainly patients with deficiency in their immune response. The grastrointestinal the tract lesions have been reported in the stomach, ileum and colon. The shape of the gastrointestinal disease is a rare disease presentation (2% to 11%). No cases of hepatic impairment has been reported so far in the literature. The aim was to report a case of patient with gastrointestinal mucormycosis with hepatic impairment in tertiary hospital. Methods: Report obtained through review of medical records, interview with the patient, photographic register, the histopathological results and literature review. The study was authorized by the committee of ethics and research HGV. Results: AMT, 25, sought medical attention complaining of diffuse abdominal pain. In research diagnoses the abdomen MRI showed solid infiltrative lesion measuring 9.0 Â 6.0 cm around, affecting the walls of the gallbladder, hilar region and segments II, III and IV liver. Tumor markers (alpha-fetoprotein, CA 19e9 and CEA), upper endoscopy and colonoscopy were normal. Laparotomy was performed which showed solid tumor infiltrating unresectable liver segments II, III and IV; stomach, transverse colon, greater omentum and abdominal wall. Histopathological found presence of entomophthoromycosis. It was treated with intravenous amphotericin B and died on day 35 of hospitalization for hepatic impairment. Conclusion: The management of these patients is still a challenge to physicians because of the difficulty of establishing an early diagnosis and the lack of therapeutic resources with proven efficacy for proper treatment.
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