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改良分叶胸肩峰动脉嵌合穿支肌皮瓣在下咽缺损合并颈前区缺损修复中的应用 被引量:5

Clinical application of modified bilobed chimeric thoracoacromiai artery perforator flap for reconstruction of hypopharyngeal defect with anterior neck skin loss
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摘要 目的 总结改良分叶胸肩峰动脉嵌合穿支肌皮瓣修复下咽缺损合并颈前区缺损的临床疗效.方法 自2013年5月至2015年9月湖南省肿瘤医院应用改良分叶胸肩峰动脉嵌合穿支肌皮瓣修复收治的7例下咽癌患者的下咽缺损合并颈前区缺损,其中男6例,女1例;年龄28~65岁,平均(50.0±3.4)岁.下咽缺损面积为5.5 cm×3.5 cm~ 12.0 cm×4.5 cm,颈前区缺损面积为8.0 cm×4.0cm~10.0 cm×4.0 cm.结果 胸肩峰穿支皮瓣面积为6.5 cm ×4.0 cm~ 13.0 cm×5.0 cm,胸大肌肌皮瓣面积为8.0cm×4.5 cm~11.0 cm×5.0 cm,血管蒂长度为6.5~8.5 cm,其锁骨下旋转点至受区边缘距离为7.0~9.5 cm.所有皮瓣完全成活,皮瓣供区均一期缝合.患者住院时间14 ~ 19 d,平均15.5d.7例患者术后随访时间分别为14、15、20、18、30、25、38个月.所有患者颈部外形良好,均可以完全经口进食,未见肿瘤复发,没有咽瘘发生,供区仅遗留线性瘢痕,胸大肌功能未见明显影响.结论 改良分叶胸肩峰动脉嵌合穿支肌皮瓣适用于下咽缺损合并颈前区缺损的修复. Objective To evaluate the efficacy of modified bilobed chimeric thoracoacromial artery perforator (TAAP) flap for the reconstruction of hypopharyngeal defect with anterior neck skin loss.Methods Between May 2013 and September 2015,modified bilobed chimeric TAAP flap was used to reconstruct complex oncologic hypopharyngeal defects in 7 patients,including 6 males and 1 female.Patients' age ranged from 28 to 65 years old (mean age 50 ± 3.4 years old).The size of hypopharyngeal defect ranged from 5.5 cm ×3.5 cm to 12.0 cm × 4.5 cm,and the size of anterior neck defect ranged from 8.0 cm × 4.0 cm to 10.0 cm × 4.0 cm.Results The size of TAAP flap was from 6.5 cm × 4.0 cm to 13.0 cm × 5.0 cm.The size of pectoralis major flap was from 8.0 cm × 4.5 cm to 11.0 cm × 5.0 cm.The length of pedicle was 6.5-8.5 cm.The distance from pivot point of flap to central point of recipient site was 7.0-9.5 cm.All flaps survived thoroughly,the donor site was closed directly in all cases.The mean hospital stay ranged from 14 to 19 days (mean 15.5 days).The follow-up was 14,15,20,18,30,25 and 38 months respectively.Patient possessed good appearance of neck surgical sites,and oral diet was restored in all patients.No recurrence,fistula,stenosis/stricture,dehiscence,or swelling occurred,only with scars left on the donor sites,and pectoralis major muscle function was completely preserved in all patients.Conclusions Modified bilobed chimeric TAAP flap is a good choice for the reconstruction of hypopharyngeal defect with anterior neck skin loss.
作者 李赞 周晓 章一新 彭小伟 周波 吕春柳 伍鹏 唐园园 彭文 毛煌兴 柳泽洋 Song Dafiang;Li Zan;Zhou Xiao;Zhang Yixin;Peng Xiaowei;Zhou Bo;Lyu Chunliu;Wu Peng;Tang Yuanyuan;Peng Wen;Mao Huangxing;Liu Zeyang(Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital and Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410008, China;Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China)
出处 《中华耳鼻咽喉头颈外科杂志》 CAS CSCD 北大核心 2018年第5期364-368,共5页 Chinese Journal of Otorhinolaryngology Head and Neck Surgery
基金 湖南省自然科学基金面上项目(13JJ5012) 湖南省科技计划项目(2014SK3002) 湖南省卫计委课题项目(B2014-111)
关键词 外科皮瓣 修复外科手术 胸肩峰动脉 Surgical flaps Reconstructive surgical procedures Thoracoacromial artery
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