锁骨上岛状皮瓣在头颈部肿瘤术后缺损修复多样性临床分析

Clinical analysis of diversity of defect repair with supraclavicular island flap after head and neck tumor surgery

目的:探讨锁骨上岛状皮瓣修复头颈部肿瘤术后缺损的多样性和临床疗效。方法:回顾性分析2017年1月—2023年3月重庆医科大学附属第一医院耳鼻喉科收治的30例头颈肿瘤术后接受锁骨上岛状皮瓣修复缺损患者的临床资料,记录缺损部位、缺损类型、术中出血量、皮瓣制取时间、皮瓣面积、存活情况以及术后并发症。结果:入组30例患者,其中男26例,女4例,年龄36~82岁。修复下咽部分缺损22例(同侧19例,对侧3例),联合对侧胸大肌皮瓣修复下咽环周缺损2例,修复颈部皮肤缺损2例,腮腺区皮肤缺损2例,颞骨区皮肤缺损1例,颈段食管缺损1例。皮瓣制取术中平均出血量8 mL,皮瓣制取平均32 min,皮瓣面积范围:5.0 cm×4.0 cm~20.0 cm×8.0 cm, 30例皮瓣存活27例(90.0%),6例并发术后咽瘘(经换药后皮瓣存活4例);1例并发静脉血栓(经换药后皮瓣坏死)。29例患者肩颈部功能(抬举、内旋、外展)未受明显影响,1例并发肩部感染经治疗后功能未受影响。结论:锁骨上岛状皮瓣是一种高度血管化的轴形筋膜瓣,易于制取,质地薄而柔软,可用于修复不同部位和不同类型头颈肿瘤术后缺损,供体部位并发症率低。在头颈部肿瘤术后修复中效果良好,值得推广。

Objective:To investigate the diversity and clinical effect of supraclavicular island flap in repairing the defect after head and neck tumor surgery.Methods:A retrospective analysis was performed on 30patients who received the repair of head and neck defects with supraclavicular island flaps at Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Chongqing Medical University from January 2017to March 2023.The sites and types of defects,intraoperative blood loss,time of flaps preparation,areas of flaps,survival of the flaps and other complications were recorded.Results:A total of 30patients were enrolled,including 26males and 4females,aged 36-82years.Among them,22patients with hypopharyngeal partial defect were repaired(19patients with ipsilateral defect and 3patients with contralateral defect).In addition,2patients were repaired with contralateral pectoralis major musculocutaneous flap around the hypopharynx,the neck skin defect was repaired in 2patients,the parotid skin defect was repaired in 2patients,the temporal bone skin defect was repaired in 1patient,and the cervical esophageal defect was repaired in 1patient.The average blood loss during the operation was 8ml,and the average_k?b_k time was 32min.The flap areas ranged from 5.0cm×4.0cm to 20.0cm×8.0cm.27of 30flaps survived(90.0%),and pharyngeal fistula occurred in 6patients after operation(4flaps survived after local dressing).One patient was complicated with venous thrombosis(the flap necrosis after local dressing).Shoulder and neck functions(lift,internal rotation and abduction)were not significantly affected in 29patients,and the function of 1patient with shoulder infection was not affected after treatment.Conclusion:Supraclavicular island flap is a highly vascularized axial fascial flap.It is easy to make,thin,and soft in texture,and can be used to repair different sites and types of postoperative head and neck tumor defects with a low donor site complication rate.Good results in post-operative repair of head and neck tumors are worth promoting.