胸大肌肌皮瓣修复鼻咽癌放疗后颈部皮肤溃疡

Repair of Neck Ulcer with Pectoralis Major Myocutaneous Flap in Patients with Nasopharyngeal Carcinoma After Radiotherapy

[目的]探讨胸大肌肌皮瓣在修复鼻咽癌放疗后颈部皮肤溃疡的作用。[方法]1991年10月-2001年10月,对16例鼻咽癌放疗后颈部皮肤溃疡进行了手术切除,再用胸大肌肌皮瓣Ⅰ期修复。[结果]本组16例中,皮瓣全部存活,术后7～12d拆线,其中4例皮瓣边缘部分愈合不良,经换药和营养支持疗法后,20～25d愈合。术后病理报告均为慢性溃疡,中位随访时间为3.5年,全部皮瓣无坏死、无新的溃疡形成。[结论]胸大肌肌皮瓣取瓣面积大,血管蒂较长,旋转度大,血运可靠,可用于鼻咽部放疗后颈部皮肤放射性坏死的较大缺损的修复。

[Objective] To investigate the role of pectoralis major myocutaneous flap in the repair of neck ulcer in patients with nasopharyngeal carcinoma after radiotherapy. [ Methods J From October 1991 to October 2001 , pectoralis major myocutaneous flap was used to repair the neck ulcer in 16 patients with nasopharyngeal carcinoma after radiotherapy. [Results ] Operations succeeded in all the 16 patients. No necrosis of the flap occured. 7 to 12 days after the operation, stitches were taken out. In 4 patients, the edge of the flap was not healing well. After treating with dressing change and nutritional support, the flap healed finally after 20 to 25 days. Pathological examination displayed chronic ulcer in all the 16 cases. The follow-up mean period was 3. 5 year. No necrosis of the flap happened, and no ulcer in the neck as well. [Conclusion]Pectoralis major myocutaneous flap can provide enough area and tissues for repair. The angio-pedicle is long and easy to rotate. Blood support of the flap is reliable. It can be used to repair the neck ulcer after radiotherapy in the patients with nasopharyngeal carcinoma.