下斜方肌皮瓣修复头颈部肿瘤术后组织缺损

Lower trapezius myocutaneous flap for repairing defects in head and neck region

目的探讨下斜方肌皮瓣的解剖基础和该皮瓣在头颈部肿瘤切除术后大型组织缺损修复重建中的作用。方法回顾性分析中山大学附属第二医院颅颌面外科2000年1月—2004年1月间应用下斜方肌皮瓣对头颈部恶性肿瘤根治性切除后的缺损进行同期修复患者24例,男14例,女10例;年龄35～76岁,中位年龄54岁。其中舌癌10例,颊癌4例,口底癌2例,腮腺癌1例,口咽癌2例,牙龈癌3例,上颌窦癌1例,右颧、额部恶性肿瘤1例;15例为初发恶性肿瘤,9例为复发恶性肿瘤;皮瓣最小为8 cm×7 cm,最大为12 cm×10 cm。结果21例患者术后皮瓣全部存活,3例皮瓣远端部分坏死,供区I期愈合。术后随访6～24个月,全部皮瓣无坏死,头颈部形态功能满意。结论下斜方肌皮瓣具有血管蒂长、旋转度大,皮瓣薄而柔软,操作简便,适合同期修复头颈部术后较大的缺损。

Objective To evaluate the anatomy basis and clinical effects of the lower trapezius myocutaneous flap to reconstruct defects in the head and neck. Methods From Jan. 2000 to Jan. 2004, lower trapezius myocutaneous flaps which were used to reconstruct the defects in the head and neck after radical tumors resection in twenty four cases in Center of Craniomaxillofacial Surgery of the Second Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively. Male was 14 ,female was 10. Ages ranged from 35 to 76 （ median = 54）. The causes of the defects were malignant neoplasom of the tongue （ n = 10）, buccal（ n = 4）, oral floor （ n = 2）, parotid （ n = 1 ）, oropharynx （ n = 2 ）, gingiva （ n = 3 ）, maxillary sinus （n = 1 ）, zygomatic and frontal part （ n = 1 ）. Fifteen patients were primary, nine patients were recurrent. The flaps ranged from 8 cm × 7 cm to 12 cm × 10 cm. Results Twenty one flaps survived fully and the other three had partial necrosis at the distal partion. Twenty two donor sites were closed primarily. Follow up 6 to 24 months, all flaps were good, the texture and color of the flaps were satisfying. Conclusions Lower trapezius myocutaneous flap is a thin, pliable and simple myocutaneous with a long pedical and wide arc of rotation, and it is preferred for reconstructing huge soft-tissues defects in the head and neck regions simultaneously.