改良胸大肌肌皮瓣修复头颈肿瘤术后组织缺损

Modified pectoralis major myocutaneous flap in reconstruction of head and neck defects

目的 总结改良胸大肌肌皮瓣修复头颈部组织缺损的经验.方法 回顾性总结2008年1月至2013年12月湖南省肿瘤医院头颈外科-肿瘤整形外科收治的107例患者的临床资料,该107例患者应用改良后胸大肌肌皮瓣修复头颈部肿瘤手术后的组织缺损,其中采用岛状弯月形肌皮瓣修复92例,采用女性下乳沟肌皮瓣修复15例;筋膜蒂的肌皮瓣56例,肌肉蒂的肌皮瓣51例;11例采用岛状肌皮瓣的皮肤面修补术腔黏膜,其肌肉面面向体外植皮,96例肌皮瓣的皮肤面修复颈部皮肤和（或）咽腔黏膜.结果 101例（94.4％）胸大肌肌皮瓣完全存活,5例（4.7％）肌皮瓣部分坏死,经换药后愈合,1例（0.9％）肌皮瓣完全坏死,更换另一侧胸大肌肌皮瓣修复成功.胸部伤口完全愈合100例,部分裂开瘢痕愈合7例.结论 改良的弯月形胸大肌肌皮瓣可以优化切取的胸壁皮肤组织量,减少胸壁皮肤张力,便于拉拢缝合伤口;保留中上段胸大肌的筋膜血管蒂的胸大肌肌皮瓣既能减少功能障碍,又能减少锁骨区组织臃肿和肌皮瓣血管蒂受压;附带中下段肌肉蒂的胸大肌肌皮瓣,可利用丰富的血运和强力抗感染的肌肉,既能覆盖保护颈总动脉,亦能改善放疗后患者颈部纤维化的情况。

Objective To report the experience of use of modified pectoralis major myocutaneous （PMMC） flaps in reconstruction of head and neck postoperative defects.Methods A total of 107 patients who underwent head and neck defect reconstruction using modified PMMC flaps after tumor rescetion between Jan 2008 and Dec 2013 were analyzed retrospectively.Results The success rate of reconstruction with modified PMMC flaps was 94.4% （101/107）.Five patients had partial flap necrosis and their wounds healed with dressing change.One patient （0.9%） had total flap necrosis,followed by the second reconstruction using contralateral PMMC flap.Conclusions The modified falcate PMMC flap can obtain optimum quantity of the skin in the chest and decreasing the closing tension of the donnor site in favor of wound healing.The pedicle without muscle will not only maintain the partial function of the pectoralis major,but also help to avoid pressing the vascular pedicle within the subclavian tunnel.The muscular element the pedicled muscles of the PMMC flap can increase the ability of the flap to resist infection,which can use for covering an exposed carotid artery and improving the neck fibrosis of irradiated patients.