延长垂直下斜方肌岛状肌皮瓣修复颅颌面软组织缺损

Extended vertical lower trapezius island myocutaneous flap in repairing large cranio-maxillofacial soft tissue defects

目的：探讨延长垂直下斜方肌岛状肌皮瓣修复颅颌面巨大软组织缺损的临床效果。方法：对4例累及颅底的颌面部恶性肿瘤患者(男3例,女1例,年龄36～63岁,平均51岁)行颅面根治术,颅面软组织缺损用颈横动脉供血的延长垂直下斜方肌岛状肌皮瓣修复,皮瓣蒂长为32～34cm,皮岛长8～12cm,宽5～7cm。结果：除1例皮瓣远端小部分坏死外,其余皮瓣全部成活,供区皮肤直接拉拢缝合,无明显肩臂功能障碍。术后随访3～12个月(平均7．3个月),1例术后6个月肿瘤复发,1例术后12个月死于肺转移。结论：延长垂直下斜方肌肌皮瓣制作较简单,效果可靠,瓣足够大,可用于颅面根治术后大面积软组织缺损的修复。

PURPOSE： This study was aimed to evaluate the clinical outcome of repairing large cranio-maxillofacial soft tissue defects by extended vertical lower trapezius island myocutaneous flap. METHODS： Four patients with malignant tumors involving the skull base （three males and one female with ages ranging from 38 to 63 years and mean age of 51 years） were treated with radical craniofacial surgery. The resultant large cranio-maxillofcial soft tissue defects were reconstructed with an extended vertical lower trapezius island myocutaneous flap based on the transverse cervical artery. The pedicle length was 32 to 34cm with the skin paddle 8 to 12cm in length and 5 to 7cm in width. RESULTS： One minor flap failure developed, there was no major flap failure , and no serious shoulder dysfunction. The donor sites were closed directly. The patients were followed up for 3 to 12 months （average 7.3 months）. One patient developed local recurrence. Another died of lung metastasis 12 months postoperatively. CONCLUSIONS： The extended vertical lower trapezius island myocutaneous flap is a simple, reliable and large flap. It is preferred for reconstruction of craniomaxillofacial soft tissue defects following craniofacial surgery.