改良胸大肌岛状肌皮瓣在颌面部缺损修复重建中的应用

Application of modified pectoralis major myocutaneous flap in maxillofacial reconstruction

目的 探讨改良的胸大肌岛状肌皮瓣在颌面部软组织缺损修复中,延长血管蒂及改善皮瓣血运的可行性.方法 自2002年至2009年,对11例颌面部软组织缺损创面,应用改良的胸大肌岛状肌皮瓣进行修复.术中通过彻底松解血管蒂（胸肩峰动脉胸肌支）,完全断开蒂部肌肉组织,将血管蒂从锁骨后骨膜下穿过,以增加血管蒂长度.切取皮瓣远端时携带部分腹直肌前鞘,并保留肋间血管的穿支与胸肩峰动脉胸肌支远端的吻合血管,以改善皮瓣远端的血运.结果 11例患者获随访2～36个月,胸大肌岛状肌皮瓣未发生坏死或部分坏死.2例患者术后发生腮腺漏,1例发生口腔内霉菌感染,1例发生轻度睑外翻.结论 改良的胸大肌岛状肌皮瓣在修复颌面部软组织缺损中可以延长血管蒂,增加转移范围,并具有改善皮瓣远端血运的优点.

Objective To investigate the clinical application of modified peetoralis major myoeutaneous flap in maxillofacial reconstruction. Methods Eleven patients with maxillofacial soft tissue defects were reconstructed with the pectoralis major mycvcutaneous flap from 2002 to 2009. The pectoralis major myocutaneous flap was elevated in true island type and the pectoral branch of the thoracoacromial vessels was anatomied and the muscles around the vessles were cut off. The flap was transfered under the clavicle subperiosteum to increase the range of it. The anterior layer of the rectus sheath was elevated with the flap in distal part to avoid damaging the perforator vascular system. Results All eleven cases of the peetoralis major myocutaneous flaps survived well. Two cases complicated salivary fistula, 1 case got mycetes infection, and 1 case got light ectropion. Conclusion The modified pectoralis major myoeutaneous flap can increase the transfer range and improve the blood supply of the distal part of the flap.