Functional exercise capacity and lung function in patients undergoing an early rehabilitation program after the Nuss procedure: a randomized controlled trial.

PURPOSE: The aim of this study was to compare the functional exercise capacity and the lung function among patients undergoing early rehabilitation with those submitted to the conventional care after pectus excavatum repair using the Nuss procedure. METHOD: Patients were randomly allocated to the early rehabilitation group (ERG) who started rehabilitation after surgery and the group of the conventional care (CG) received routine care of the institution. They were evaluated before surgery (preoperative) and in hospital discharge day (postoperative). RESULTS: Forty patients were evaluated, twenty in each group. All patients presented a significant reduction in FVC, FEV1, and PEF in the postoperative period, there was no statistically significant difference between groups. There was significant different in postoperative functional exercise capacity between the ERG and CG (506.26 ± 66.54 vs 431.11 ± 75.61, p = 0.02) and the difference between distance walked in the preoperative and postoperative period was lower in the ERC than in the CG (76.57 ± 49.41 vs 166.82 ± 70.13, p < 0.001). CONCLUSION: Patients undergoing the early rehabilitation after the Nuss procedure presented a better postoperative functional exercise capacity in hospital discharge day compared with patients in the conventional group, with no difference in lung function between groups.

Reinserção psicossocial de paciente jovem através de desarticulação interescápulo torácica e hemitoracectomia / Psychosocial rehabilitation of a young patient through interscapular thoracic disarticulation and hemithoracectomy

Na era das cirurgias minimamente invasivas, parece controverso advogar grandes operações. Entretanto, ainda há espaço para grandes intervenções oncológicas. É relatado caso de paciente de 23 anos de idade portador de tumor desmoide em hemitórax direito, com deformidade e erosão de arcos costais, atelectasia parcial do pulmão ipsilateral, compressão e desvio contralateral do mediastino, invasão de nervos do plexo braquial, vasos subclávios e pleura apical direita. Realizada toracectomia, ressecção de tumor em mediastino, amputação do membro superior direito, escapulectomia e reconstrução da parede torácica com tela de márlex e metilmetacrilato e confecção de retalho fasciocutâneo. O paciente encontra-se em seguimento ambulatorial com suas funções diárias quase recuperadas, limitado apenas nas atividades que envolviam o membro desarticulado. Em casos selecionados devem ser consideras grandes intervenções com o objetivo de ressecção R0 (ressecção com margens cirúrgicas livres) e melhora na qualidade de vida, atentando-se sempre para a ressocialização.

In the era of minimally invasive surgery, advocating large operations seems controversial. However, there is still room for major oncologic interventions. This is report of a 23 yearold patient with desmoid tumor in the right hemithorax, deformed and eroded ribs, ipsilateral lung partial atelectasis, contralateral mediastinal compression and shift, invasion ofnerves in the brachial plexus, subclavian vessels and right apical pleura. Thoracectomy was performed with resection of the tumor in the mediastinum, right upper limb amputation, scapulectomy, and chest wall reconstruction with methylmethacrylate and marlex screen, and use of a fasciocutaneous flap. The subject is in follow up as an outpatient andhas almost recovered his daily functions, which are now limited only for activities involving the inarticulate member. Selected cases should be considered for major interventions with aiming at R0 resection (resection with free surgical margins) and improved quality of life, always bearing in mind the need for rehabilitation and socialization.

La toracoplastia / Thoracoplasty

La toracoplastia disenada por Sehede, es la reseccion parcial o total de la pared toracica, usada para el tratamiento de secuelas de tuberculosis pleuropulmonar, reduccion de cavidades residuales, o exceresis de neoplasias de pulmon con invasion a pared o tumores de pared toracica. Las indicaciones pueden ser pulmonares, pleurales o en cavidades residuales postoperatorias. En nuestra casuistica, fueron sometidos a toracoplastia 5 pacientes de sexo masculino por secuelas sangrantes de tuberculosis pulmonar y supurativas pleurales; se hizo reseccion entre 3 o 4 costillas. Los resultados fueron satisfactorios en tres pacientes y fracasaron en dos. Esto nos hace ver que a pesar de lo antiguo del procedimiento en la actualidad aun podemos contar con el para los casos de secuelas bacilares sin condiciones de reseccion pulmonar.