胸大肌皮瓣在颈部放射性溃疡修复中的应用

The application of pectoralis major flap in repairing neck radiation ulcers

目的：总结胸大肌岛状肌皮瓣在颈部放射性溃疡创面中的应用效果.方法：1997年3月～2013年9月,对21例放射治疗导致的颈部溃疡创面的临床资料进行回顾性分析.16例应用同侧带蒂胸大肌肌皮瓣进行Ⅰ期修复,其中2例术中注射PRP至溃疡周围正常皮肤;5例Ⅱ期修复：先行伤口清创＋VSD吸引,每日庆大霉素加重组人表皮生长因子溶液VSD冲洗创面,伤口明显改善后,再应用同侧带蒂胸大肌肌皮瓣进行修复.结果：18例胸大肌皮瓣成活良好;3例（Ⅰ期修复）皮瓣远端部分坏死,其中1例经换药后愈合,2例清创术后采用局部皮瓣修复后愈合.结论：胸大肌皮瓣血管蒂长,血运丰富,可修复创面面积大,易成活,采用VSD及PRP处理创面后,有助于胸大肌皮瓣在修复颈部放射性溃疡创面的愈合.

Objective To summarize the effect of island pectoralis major muscle flap reconstructive neck of radioactive ulcer.Methods The clinical date of 21 cases,who were reconstructed for radiationulcer of the neck with pectoralis major myocutaneous flap from March 1997 to September 2013 at our department,were retrospectively analyzed.16 cases of ipsilateral pedicled pectoralis major muscle flap applications perform a repair,including two cases of intraoperative injection of PRP to the surrounding normal skin ulcers;5 cases of repair Ⅱ：first wound debridement ＋ VSD attract,gentamicin plus recombinant human epidermal growth factor solution wash the wound with VSD daily,the wound was significantly improved,and then apply the same side pedicled pectoralis major muscle flap to repair.Results 18 cases of pectoralis major flaps survived well;3 cases （primary repair） the distal portion of the flap necrosis,one patient healed after changing dressing,two cases of debridement using a local flap after healing.Conclusions Pectoralis major muscle flap vascular pedicle length,nutrient rich blood supply,repair large wound area,and easy to survive,after treatment the wound by using VSD and PRP can help pectoralis major flap and neck radiation ulcer healing.