肋骨-胸大肌复合瓣修复口腔颌面部大范围复合缺损

目的：探讨肋骨-胸大肌复合瓣在修复口腔颌面部大范围复合性缺损中的可靠性及临床效果。方法：6例口腔颌面部大范围复合缺损患者采用肋骨-胸大肌复合瓣进行修复重建。皮瓣包括胸大肌肌皮瓣和第五肋骨,并在第五肋骨膜与胸膜壁层之间分离。根据软组织及下颌骨缺损的范围设计皮瓣,皮瓣大小为5 cm×8 cm-10 cm×18 cm,肋骨长度为7-10 cm。修复穿通性缺损时,将胸大肌皮瓣制成双叶瓣。结果：6例肋骨-胸大肌复合瓣全部成活,仅1例出现边缘少量坏死。手术后复查胸片,未出现气胸,仅1例出现胸腔少量积液。术后下颌骨形态和功能良好,口腔全景片显示骨瓣愈合良好。结论：肋骨-胸大肌复合瓣制备简单,安全可靠,适合修复口腔颌面部大范围、复合缺损。

Reconstruction of large and complex defects in oral and maxillofacial region with rib-pectoralis major myocutaneous composite flap

PURPOSE： To review the effectiveness and reliability of the rib-pectoralis major myocutaneous composite flap for large and complex defects in oral and maxillofacial region. METHODS： Six patients who underwent composite defect reconstruction using rib-pectoralis major myocutaneous composite flap were investigated. We designed the flap to include the pectoralis major myocutaneous flap and the 5th rib. In particular, we separated the rib periosteum from the pleura, to retain the pleura and avoid thoracotomy. The flap size was 5 cm×8 cm to 10 cm×18 cm, with the rib being 7 to10 cm according to the mandible length to be reconstructed. RESULTS： All flaps survived, with 1 case developing marginal necrosis. No major complications occurred. There was little pleural effusion in 1 case and no pneumothorax. The function and contour of the mandible were excellent. X-ray films were taken after reconstruction showed good bone healing. CONCLUSIONS： The rib-pectoralis major myocutaneous composite flap is safe and reliable. It can guarantee a blood supply to the ribs while meeting the needs to reconstruct complex defects of the oral and maxillofacial region.