组织量丰富的胸大肌肌皮瓣在头颈部缺损修复中的技巧

The experience of abundant amount of pectoralis major myocutaneous flap tissue in restoring parenchyma defect of head and neck

目的:探讨组织量丰富的胸大肌皮瓣在头颈部缺损修复中的手术技巧,最大限度减少并发症。方法:对23例(24侧)肥胖患者利用改良的方法制备组织量丰富的胸大肌皮瓣修复颈部各种缺损,首先固定肌肉,再将皮肤与缺损的皮肤或黏膜对缝;修复缺损后对胸大肌肌皮瓣周围潜在的死腔进行负压引流。结果:23例患者中有1例在制备胸大肌肌皮瓣过程中误伤胸肩峰动脉,改为制备另一侧胸大肌皮瓣。制备完好的23例胸大肌肌皮瓣全部成活,只有1例远端部分坏死,经换药后愈合。本组有3例受区感染形成咽漏,换药治疗后愈合;1例受区皮肤与皮瓣皮肤部分裂开,换药处理后愈合;1例供区皮下积血,及时清除淤血后很快愈合。结论:组织量丰富的胸大肌肌皮瓣虽然臃肿,制备和修复时比较困难,但只要掌握一定的围手术期处理技巧,仍然是修复头颈部缺损的良好材料。

Objective：Explore the skills to flap the defects of the head and neck with myocutaneous of pectoralis major which has rich amount of organization to minimize complications.Method：Various of neck defects will be repaired when the myocutaneous flap of pectoralis major from obese male or/and female has been prepared with improved methods.First of all,the muscle must be fixed.Then we have to suture the skin and the defect of skin or mucous membrane;the potential closed cavities around the myocutaneous flap must be drainaged with the negative pressure after repaired.Clinical data of 23（24sides）patients undergoing the repair in our hospital between January 2008 and December 2014 were collected and reviewed retrospectively.Result：One of 23 cases was injured the thoracoacromial artery in the preparation process of myocutaneous flap by the operator,then we operated on the other side.All of the pectoralis major myocutaneous flaps has been survived except 1case which was necrosis in distal partial of pectoralis major muscle flap,but healed after changing dressing.Three cases with pharyngeal leakage because of the infection were also healed after changing dressing;skin and skin flap partial dehiscence happend in 1cases,but also healed after dressing;1cases with subcutaneous hemorrhage was healed after cleaning up hematocele.Conclusion：The pectoralis major myocutaneous flap is still a good material for the repair of head and neck defects as long as the management skill in perioperative has been mastered properly,even though the one with rich amount of organization is bloated and the preparation and repair is difficult.