舌骨下肌皮瓣静脉回流障碍的预防性处理

Preventive management of veinous backflow obstruction of infrahyoid myocutaneous flap

目的 针对部分甲状腺上静脉回流障碍的舌骨下肌皮瓣,采用切断静脉再吻合的舌骨下肌皮瓣和保留非常见型回流静脉的舌骨下肌皮瓣等方法提高该皮瓣的成活率。方法 采用同侧舌骨下肌皮瓣一期修复口腔肿瘤术后缺损38例,包括切断静脉再吻合的舌骨下肌皮瓣6例;带动静脉蒂舌骨下肌皮瓣32例,其中以颈外浅静脉和甲状腺上静脉2条静脉为回流静脉的5例,以面总静脉和甲状腺上静脉2条静脉为回流静脉的3例,以1条甲状腺上静脉为回流静脉的24例。结果 本组37例肌皮瓣完全成活,肌皮瓣成活率97.4％。1例肌皮瓣远心端皮肤坏死约5％,剪除坏死组织后皮瓣成活。结论 保留颈外浅静脉或面总静脉等非常见型静脉为该肌皮瓣的回流静脉和采用切断静脉再吻合的舌骨下肌皮瓣的手术方法,是解决部分舌骨下肌皮瓣静脉回流障碍的有效措施。

Objective To improve the survival rate of infrahyoid myocutaneous flap by cutting off the short vein, anastamosing other veins, and preserving the variant back flow veins in case of veinous backflow obstruction of infrahyoid myocutaneous flap in the superior thyroid vein. Methods The same side of infrahyoid myocutaneous flaps were used for immediate reconstruction after radical resection of oral cavity cancer in 38 patients, including 6 cases of infrahyoid myocutaneous flaps in which short veins were cut off and followed by anastamosing them with others, and 32 cases with the pedicle of the arteries and veins. Of the 32 cases, external jugular superficial veins and superior thyroid veins were used as backflow veins in 5 cases, in another 3 facial veins and superior thyroid veins were used, and superipr thyroid veins exclusively in the rest 24 cases. Results All infrahyoid myocutaneous flaps completely survived in 37 cases (94.7% ), while in one case approximately 5% of the distal part of myocutaneous flap was necrotic, who also survived after the necrotic tissue had been removed. Conclusion It is effective to deal with the veinous backflow obstruction of myocutaneous flap by preserving the variant veins, such as the external jugular vein or facial veins, and cutting off the short veins followed by anastamosing other veins of infrahyoid myocutaneous flaps.