岛状肌皮瓣修复头颈部肿瘤术后缺损并发症与预防

Reconstruction of the Tissue Defects with Island Myocutaneous Flap in Head and Neck Surgery:Analysis and Prevention of Complications

目的:探讨应用带血管蒂岛状肌皮瓣修复头颈肿瘤术后缺损的并发症及预防措施。方法:回顾性分析1985-2003年本科收治的104例头颈部肿瘤患者术后应用4种岛状肌皮瓣(额瓣、舌骨下肌皮瓣、斜方肌皮瓣、胸大肌皮瓣)进行一期修复的临床资料。结果:104例中,4例(3.8%)肌皮瓣全层坏死,9例(8.6%)皮岛皮肤部分坏死,但肌层存活,换药后自愈,肌蒂下血肿7例(6.7%),深部感染11例(10.5%),本组皮瓣Ⅰ期成活率87.6%(91/104),Ⅱ期成活率8.6%(9/104),100例重建术后放疗40～70Gy,无1例再发生肌皮瓣坏死、伤口裂开等并发症。结论:预防岛状肌皮瓣修复头颈部肿瘤术后缺损并发症的关键在于合理设计皮瓣,保证皮瓣的血供,充分的术中止血和术后引流。

Objective：To explore the complications and preventive measures in reconstruction of the tissue defects with island myocutaneous flap in head and neck surgery.Methods：We summarized retrospectively on the clinical data of 104 patients with carcinoma of head and neck reconstructed at the same stage of tumor resection by 4 types of island myocutaneous,including forehead,infrahyoid,trapezius and pectoralis major myocutaneous flap.Results：Of the 104 cases,island myocutaneous flaps showed full survival in 91 cases,all necrosis in 4（4/104,3.8%）,partial necrosis of skin island but viable muscular layer in 9（9/104,8.6%）,haematoma in 7（7/104,6.7%）and infection in 11（11/104,10.5%）.Ⅰstage and Ⅱ stage survival of the flaps were 87.6%（91/104）and 8.6%（9/104）,respectively.100 cases of these patients underwent radiotherapy（40Gy-70Gy）after reconstruction and no one suffered complications of myocutaneous flap necrosis and wound dehiscence.Conclusion：It is important to design the flaps according to tumor region and defect range.The key to prevent complications is to ensure the blood supply of flaps,adequate hemostasis and continuous post-operative drainage.