带蒂胸大肌肌腱瓣移位修复颈部气管壁缺损的解剖及初步临床应用

Anatomical and preclinical study of repair of cervical tracheal wall defects with vascularized pectoralis major tendon flaps

目的 解剖观察为带蒂胸大肌肌腱瓣移位修复颈部气管壁缺损的可行性,初步探讨其临床疗效. 方法 在32侧成人侧胸部标本上测量胸大肌肌腱长、宽、厚,观察胸肩峰动脉及胸肌支起点、分布情况,测量以胸肩峰动脉胸肌支为蒂的胸大肌肌腱瓣的血管神经蒂长度、旋转半径及其与气管受区的距离;并在尸体上摹拟手术.临床应用以胸肩峰动脉胸肌支为蒂的胸大肌肌腱瓣移位修复颈部气管前壁3.0 cm×1.5 cm缺损并切口感染患者1例,术后随访其疗效. 结果 胸大肌肌腱长（22.9±0.9）mm、宽（51.0±2.4）mm、厚（5.81±1.35） mm.以胸肩峰动脉胸肌支为蒂的胸大肌肌腱瓣血管蒂长度为（89.3±5.3） mm,旋转半径为（121.7±8.2）mm,其旋转点至受区中心距离为（96.5±8.9）mm.术后随访患者5个月,患者颈部外形良好,无气肿,发音正常.术后3个月颈部CT扫描示气管修复区管腔前后径2.6 cm,左右径1.8 cm,管腔无明显狭窄. 结论 以胸肩峰动脉胸肌支为蒂的胸大肌肌腱瓣移位可有效修复颈部气管壁缺损.

bjective To provide an anatomical basis for repairing the defect of cervical tracheal wall with vascularized pectoralis major tendon flaps.Methods Thirty-two lateral thoracic necrotomies were studied for the following aspects.Measurement of pectoralis major tendons＇ length,width and thickness.Anatomy of thoracoacromialartery,pectoral branches：origin,distribution.Measurement of length of pedicle,rotated radius of flaps and length from recipient site.An imitative operation was undergone on a specimen of corpse.One patient was undergone the operation of repairing the 3.0 cm × 1.5 cm defect of anterior cervical trachea wall,accompanying with incision infection,with pectoralis major tendon flap.Results Length of pectoralis major tendon：（22.9 ± 0.9）mm.Width of tendon：（51.0±2.4）mm.Thickness of tendon：（5.81±1.35）mm.Length of pedicle：（89.3± 5.3） mm.The radius of pedicle pectoralis major myotendinous flap：（121.7± 8.2）mm.The distance from pivot point of flap to central point of recipient：（96.5± 8.9）mm.Patient possessed normal pronunciation,good appearance and no emphysema at 5 months＇ follow-up.Tracheal lumen,measured 2.6 cm in the anteroposterior dimension and 1.8 cm in the lateral dimension,showed no recurrence of obvious stenosis in cervical computed tomography at 3 month postoperatively.Conclusion Pedicle pectoralis major tendon flaps,originated from thoracoacromial artery pectoral branches can repair cervical tracheal wall defects effectively.