胸肩峰动脉穿支皮瓣修复下咽癌切除术后缺损

Clinical application of thoracoacromial artery perforator flap for hypopharyngeal reconstruction

目的 探讨胸肩峰动脉穿支皮瓣修复下咽癌切除后遗留缺损的临床效果.方法 2011年6月至2015年11月,应用带蒂胸肩峰动脉穿支皮瓣对13例下咽癌根治性切除后的缺损进行修复重建,缺损面积为7.0 cm×4.5 cm～8.5 cm×5.5 cm.以多普勒超声血流探测仪探查胸肩峰动脉穿支发出点,以肩峰、剑突连线为轴线设计长、宽大于缺损区0.5 ～1.0 cm的皮瓣,将皮瓣通过胸大肌锁骨部深面、锁骨下面和胸锁乳突肌深面转移至受区,供区直接拉拢缝合.结果 皮瓣切取面积为7.0cm×5.0 cm～9.5 cm×6.0cm,血管蒂长度为7.5 ～9.0 cm,其旋转点至受区中心距离为9.0～10.5 cm.13例皮瓣全部存活,术后随访8～42个月,所有患者颈部外形良好,未见肿瘤复发,未发生咽瘘、伤口裂开和肿胀等情况,重建的下咽腔无狭窄,供区遗留瘢痕,胸大肌功能未见明显影响.结论胸肩峰动脉穿支皮瓣可以较好地修复下咽癌术后下咽部缺损.

Objective To explore the clinical effect of thoracoacromial artery perforator （TAAP） flap as a reconstructive option for hypopharyngeal defects.Methods Between June 2011 and November 2015,TAAP flap was used to restore oncologic hypopharyngeal defects in 13 patients with recurrence of hypopharyngeal carcinoma.The size of hypopharyngeal defects ranged from 7.0 cm× 4.5 cm to 8.5 cm × 5.5 cm.Doppler was used to detect the location of thoracoacromial artery perforator.The flap was designed on the line joining the acromion to the xiphoid process with the size 0.5-1.0 cm larger than the defect,the flap was passed under the clavicular head of the pectoralis major and under the clavicle bone and sternocleidomastoid to the recipient site for insetting.The donor site was closed directly.Results The size of TAAP flap is from 7.0 cm×5.0 cm to 9.5 cmu×6.0 cm.The length of pedicle is 7.5-9.0 cm.The distance from pivot point of flap to central point of recipient site was 9.0-10.5 cm.All 13 flaps survived completely,the defect at donor site was closed directly in all cases.Good appearance was achieved at 8 months to 42 months＆#39; follow up,with no recurrence,fistulas,stenosis/strictures,dehiscence,or swelling,only linear scars were left on the donor sites,pectoralis major muscle function was completely preserved in all patients.Conclusions TAAP flap is a good choice for reconstruction of hypopharyngeal defects.