胸外侧切口锁骨下隧道胸大肌肌筋膜瓣在口腔修复中的应用

The applications of pectoralis major myofascial flap with the lateral thoracal incision through subclavicular channel in oral reconstruction

目的:采用胸外侧切口锁骨下隧道的胸大肌肌筋膜瓣修复口腔缺损,扩大传统胸大肌肌皮瓣的使用范围。方法:在传统胸大肌肌皮瓣基础上,将胸前壁切口改为胸外侧以增加美观;使用胸大肌及其筋膜替代皮肤,以减轻组织瓣的臃肿,改善血运,避免破坏女性乳房功能和外观;应用锁骨下隧道增加筋膜瓣的旋转半径,并对胸大肌肌筋膜瓣的血供特点、上皮化过程及锁骨下隧道的安全性进行临床观察。结果:肌筋膜瓣27例,26例成活,总成活率96％(26/27)。12例发生不同并发症,占44％(12／27),主要为筋膜瓣部分坏死脱落(5例)和口咽颈部瘘管(3例)。其中4例需局部手术处理(15％),无与锁骨下隧道直接有关的并发症。所使用方法可增加旋转半径5-8cm。筋膜上皮化在术后4周左右完成。结论:所介绍方法可明显增加组织瓣的旋转半径,有效地保存乳房的形态和功能,并使瘢痕位于相对隐蔽位置。该方法可有效扩大传统胸大肌肌皮瓣的使用范围。

PURPOSE: To evaluate the applications of pectoralis major myofascial flap with the lateral thoracal incision and subclavicular channel in oral reconstruction with the purpose of expanding the scope of applications of this flap. METHODS: The incision location was shifted to the lateral thoracal wall to improve the cosmetic appearance; The pectoralis major myocutaneous flap was substituted for myofacial flap to reduce the flap bulk, improve the blood supply and save both cosmesis and function of the breasts in women; The myofacial flap transferred under clavicle to the neck to increase the pedicle length, giving valuable extra scope for placement in distant sites. The characteristics of blood supply of the pectoralis major myofacial flap, the processing of epithelization and the safeness of subclavicular channel were discussed. RESULTS: The survival rate of the flaps was 96%(26/27). There was one flap failure. Various complications occurred in 12 cases, accounting for 44% . Among them, 4 cases required surgical treatment. There were no complications associated with the subclavicular channel. The method discussed can increase the pedicle length about 5-8cm. The ep ithilization completed in 4 weeks. CONCLUSIONS: The methods described in this paper can increase the rotation radius obviously and can save the cosmesis and function of the breasts in women. The scars were not notable. The application scope of pectoralis major myocutaneous flap can be extended effectively by this method.