下斜方肌肌皮瓣修复颅颌面部巨大缺损的临床应用

Clinical application of the lower trapezius myocutaneous flap for repair craniofacial maximal defect

目的探讨下斜方肌肌皮瓣的解剖学基础及临床应用效果. 方法在对斜方肌肌皮瓣的显微外科解剖学研究及跨越中线区皮瓣血供研究的基础上,应用超长下斜方肌肌皮瓣21例、超宽超长下斜方肌肌皮瓣6例,修复因各种外伤原因或肿瘤切除后致颅颌面大面积组织缺损22例,重度颌颈瘢痕粘连5例. 结果临床应用27例,皮瓣最大面积42 cm×11 cm,最宽达15 cm,除3例超长下斜方肌肌皮瓣远端2～4 cm表皮糜烂经换药愈合外,余皮瓣均完全成活,术后经3～12个月随访,效果满意. 结论下斜方肌肌皮瓣血运可靠,手术切取简便安全,皮瓣蒂较长,旋转弧度大,转移后远端可以到达颅顶甚至前额,超宽皮瓣覆盖范围更大,是一期修复颅顶和颈前大面积组织缺损较好的方法.

Objective To explore the anatomy basis and clinical effection of the extralong ＆ extrawild lower trapezius myocutaneous flap. Methods Based on anatomical study, the extralong or the extralong ＆ extraxwild lower trapezius myocutaneous flaps were desinged and transferred to reconstruct 27 cases of the maximal scalp or craniofacial soft-tisse defect. The maximum size of flap was up to 42 cm×11 cm, and the wildest size up to 15 cm. Results Twenty-four flaps survived and the other 3 flaps had partial necrosis at the distal partion. Follow-up 3 to 12 months, the exture and color of the flaps were good. Conclusion This kind of flap has reliable blood supply and longer pedical, can corver larger area, could be operated conveniently and safely. It is an ideal method to repair the large scalp or craniofacial soft-tissue defect one stage.