斜方－菱形肌岛状肌皮瓣在颅底及颌面肿瘤外科的应用

Clinical Application of Rhombotrapezious Island Musculocutaneous Flap for Skull Base and/or Craniomaxillary Operation with Malignant Tumor

解剖９具尸体，其中５具新鲜尸体行动脉血管颜料灌注，研究１８侧斜方—菱形肌岛状肌皮瓣的血供来源及分支分布，结果显示，该肌皮瓣为肩胛背动脉和颈横动脉降支的双重血供，二者共于起于甲状颈于者占６７％，肩胛背动脉单独起于锁骨下动脉者占３３％。临床应用该组织瓣６例，一期修复颅底及颅颌部恶性肿瘤根治性手术后的组织缺损，获较满意的效果。因此，斜方—菱形肌岛肌皮瓣是颅底及颅颌外科的一个可信赖的组织瓣。

Regional pedicled musculocutaneousflaps are the mainstay of the head and neck reconstruc-tion. They provide a rapid, kighly reliable and single-staged technique that is applicable in most cases. Therhombotrapezious island musculocutaneous flap isvaluable in the base and craniomaxilloface reconstruc-tion. In this study we updated our experience with therhombotrapezious island musculocutaneous flap(RTIMF) in 6 cases from 1989 to 1993. Dissectionswere perfomed on 9 cadavers, 4 preserved and 5 fresh,yielding 18 pairs or dorsal scapular and transverse cer-vical artery for evaluation. In the five fresh cadavers.the arteries were selectively cannulated and injectedwith colored latex. 67% with dorsal scapular andtransverse cervical artery commonly arose from thethyro-cervical trunk. 33% with the dorsal scapularartery directly arose from the second part of the sub-clavian artery.In the period of 1989-1993,6 rhombo-trapezious island musculocutaneous flaps with vascu-larized pedicle were used for immediate repair in theskull base or craniomaxillary cancer operations. Therewas no complication of the flaps. Donor site complica-tions were relatively minor. The disturbance in shoul-der function was well tolerated. we advocated the in-corporation of both the greater and lesser rhomboidmuscle to form the compound rhombotrapezious flapsto enkance the vascu lar supply to the overlying skin.The major advantage of the RTIMF are that it pro-vides a long paddle of thin pliant , hairless skin andmuscle that can be rotated as far as the craniomax-illoface and scalp in a single stage, It offers the longestarc of rotation and thus the greatest versatility for theskull base or craniomaxillary reconstruction.