改良的胸大肌皮瓣制备技术及其临床应用

A modified technique for harvesting pectoralis major myocutaneous flap and its clinical application

目的 介绍一种改良的胸大肌皮瓣的制备方法。方法 ①根据胸大肌皮瓣的血流动力学特点设计皮岛,使得皮岛的血供更为安全可靠;②采用胸大肌内侧入路法,使得对血管蒂的定位更加快速和安全;③保留了胸大肌外侧的大部分肌纤维,使得胸大肌的功能得以部分保留;④肌皮瓣的血管蒂不携带肌肉,使其成为真正的岛状瓣,既延长了血管蒂又防止了血管蒂在锁骨表面的受压;⑤必要时血管蒂自锁骨后方通过,进一步延长了血管蒂。结果 采用该改良法共完成胸大肌皮瓣移植12例,其中11例用于口腔颌面部缺损修复,1例用于胸壁缺损修复。所有肌皮瓣的制备时间均小于40min,出血量小于20ml。术后全部肌皮瓣均获得均100％成活。结论 改良的胸大肌皮瓣制备方法提高了肌皮瓣血供的可靠性,并使得制备更加快速、简便,同时该技术还延长了肌皮瓣的血管蒂,使得肌皮瓣的应用更加灵活和有效。

Objective To introduce a modified technique for harvesting pectoralis major myocutaneous (PMMC) flap . Methods The modified technique includes: ① the skin island was designed according to the circulation and hemodynamics of the flap;②using a medial approach to elevate the pectoralis major and to locate the pedicle of the flap;③ the lateral part of the pectoralis major muscle was undisturbed, thus preserving partial function of this muscle;④the pedicle of the flap did not contain any muscle, making PMMC flap into a true island flap; ⑤if necessary, the pedicle of the flap could be passed to the neck through a retro- clavicle approach, thus further lengthing the pedicle. Results From April 1999 to April 2002,12 PMMC flaps were transferred by using this modified technique. All the flaps survived completely without either donor or recipient site complications. Conclusion The modified technique greatly improved the circulation of PMMC flap. It also provides simple, quick,and safe approach for harvesting PMMC flap. This technique greatly lengths the pedicle of flap,making this flap more reliable and versatile in head and neck reconstruction.