改良带蒂胸大肌皮瓣修复头颈部晚期恶性肿瘤术后复杂缺损的临床应用

The improved pedicled pectoralis major myocutaneous flaps in reconstruction of complex surgical defects following resection of advanced head and neck malignancies

背景与目的:带蒂胸大肌皮瓣因为具有多种优点一直是头颈部组织缺损修复应用的经典组织瓣。当今,随着显微技术普及和提高,游离组织瓣逐步取代了带蒂组织瓣。然而,临床上并非所有病例均适宜接受游离组织瓣修复手术,邻近带蒂组织瓣更安全可靠。拟通过改进胸大肌皮瓣的制备及修复方法,探讨改良带蒂胸大肌皮瓣在修复头颈部晚期恶性肿瘤术后复杂缺损时的应用。方法:在皮瓣设计方案及制备方法等多方面改进胸大肌皮瓣,修复头颈部晚期恶性肿瘤术后复杂缺损患者51例。结果:51例改良胸大肌皮瓣全部存活,缺损区修复后外形和供区外形情况满意,缺损区功能得到良好的恢复,供区术后功能损伤最小化。结论:胸大肌皮瓣在设计及制备方法等多方面的改良,提高了对头颈部恶性肿瘤术后复杂缺损修复的范围及修复的距离,减少皮瓣坏死的概率,术后供区和受区外形、功能效果满意,目前仍然是头颈部恶性肿瘤术后缺损的重要修复手段之一。

Background and purpose： The pedicled pectoralis major myocutaneous flap has been a common choice of tissue flaps for head and neck reconstruction. Nowadays, with rapid advancement in microsurgery, free flaps gradually replace the pedicled flaps. However, not all patients are good candidates for reconstruction surgery using free tissue flaps. Adjacent pedicled flaps are safer and more reliable. This paper explores potential application of pedicled pectoralis major myocutaneous flap in reconstruction of complex surgical defects following resection of advanced head and neck malignancies through modification of their preparation and repair method. Methods： Flap design scheme and method of preparation were modified to improve the pectoralis major muscle flap. Fifty-one patients with surgical defects from resection of head and neck malignancies received reconstruction surgery using modified pectoralis major muscle flaps. Results： Modified pectoralis major muscle flaps survived completely in 51 patients. The area of defect regained its shape and appearance after reconstruction surgery. The area of defect obtained excellent functional recovery. Postoperative functional injuries to the donor sites were minimized. Conclusion： Modification in designing and preparing method of the pectoralis major muscle flap improved repair range and distance in reconstruction of complex surgical defect following resection of head and neck malignancies. It also reduced necrosis rate of skin flaps. Postoperative donor and recipient sites regained their appearance and functions successfully. The pectoralis major muscle flap is one of the important tissue flaps used in reconstruction of surgical defect following resection of a head and neck malignancy.