胸大肌皮瓣岛状设计的技巧和风险控制

Techniques for island design of pectoralis major muscle flap and risk control

1胸大肌皮瓣的演变历史在人类征服恶性肿瘤的征程中,外科根治切除术是最主要的治疗手段之一;如何重建肿瘤切除后的组织缺损,一直是肿瘤外科的难题。头颈肿瘤切除术后的修复重建经历了不同发展阶段,从早期采用颈胸随意皮瓣进行局部修复,到20世纪八十年代以轴型皮瓣为代表的局部皮瓣修复,再到随后出现的游离皮瓣修复重建技术。作为交叉学科,头颈外科包括综合医院的耳鼻咽喉头颈外科、口腔颌面外科和肿瘤医院的头颈外科等三个亚学科,不同亚科病谱互有差异。

The pectoralis major muscle flap has been clinically used for more than 40 years.When harvesting the traditional pectoralis major muscle flaps,it is necessary to cut the upper half of the pectoralis major muscle,and use the thoracoacromial vessels and its surrounding pectoralis major muscle as the pedicle,resulting in the loss of the function of the pectoralis major muscle.Hypertrophic pedicle also squeezes the responsible vessels and prevents the flap from being transferred to recipient area,often leading to the partial necrosis of the flap end.The author proposes an improved method to harvesting pectoralis major muscle island flap,and summarizes it as a"ten-step procedures".The key point is to identify the"lowest penetrating muscle point"(LPMP)during the operation,and points out that it is safe to cut off the muscle pedicle 2 cm above LPMP.The pectoralis major muscle island flaps not only preserves the function of the donor site′s pectoralis major muscle to the utmost extent,better restores the swallowing and vocal function of the recipient site,but also improves the safety of flap harvesting,which will be benefit to patients.