Selective transposition of the pectoralis major myocutaneous flap: an electromyographic evaluation

Although it has been postulated that the segmental anatomy of the pectoralis major muscle should allow intact motor function to be preserved at the donor site after a myocutaneous island flap has been transposed, the functional outcome of this selective harvesting technique has not been previously investigated. In this study the degree of innervation of the residual pectoralis major muscle on the chest after traditional (10 patients) and selective (10 patients) pectoralis major myocutaneous flap transposition has been evaluated using postoperative electromyography. According to the data obtained, while an intact innervation of the external segment is maintained utilizing both techniques, it is impossible to preserve functional innervation of the remaining sternocostal strip medial to the donor site during a pectoralis major myocutaneous flap transposition, even after its selective harvesting.     

A model for staged compression of the vascular pedicle in a porcine myocutaneous flap

There is a need for a laboratory model that would allow assessment of the effects of vascular pedicle compression in the myocutaneous flap. We describe a technique as used in the pig that responds to the needs of technical reproducibility and sequential compromise of vascular flow as measured by laser velocimetry and dermofluorometry.     

带血供股骨干前外侧面骨膜瓣移位术的临床应用

目的　探讨带血供股骨干前外侧面骨膜瓣移位术的临床应用价值。　方法　解剖观测3 8侧经红色乳胶灌注的成人下肢标本 ,明确股骨干前外侧面骨膜的血供来源、分布和吻合。在此研究基础上 ,设计带血供股骨干前外侧面骨膜瓣移位术 ,修复 2 2例股骨干骨不连和骨缺损。　结果　临床应用 2 2例 ,获 1～ 5年随访 ,均取得良好效果。骨膜瓣面积为 8cm× 4cm至 10cm× 5cm。　结论　该骨膜瓣具有手术操作简便、安全和易于推广等优点 ,并在同一手术入路完成病损区处理和骨膜瓣切取 ,具有很强的临床实用价值。     

带蒂下部前锯肌肌皮瓣及筋膜皮瓣的临床应用

目的：探讨带蒂下部前锯肌肌皮瓣及筋膜皮瓣修复皮肤软组织缺损的可行性。方法：采用5例肌皮瓣、4例筋膜皮瓣修复皮肤软组织缺损患者共9例，其中腋窝3例，颈部2例，胸部2例，上臂1例，背部1例。结果：9例皮瓣完全存活，无供血不足及静脉回流障碍，供区瘢痕隐蔽，无“翼状”肩胛出现。结论：下部前锯肌肌皮瓣或筋膜皮瓣血管蒂长，血管管径粗，便于操作，皮瓣不臃肿，易于塑形，供区并发症少，是一种值得推广应用的皮瓣。     

下斜方肌肌皮瓣修复颅颌面部巨大缺损的临床应用

目的探讨下斜方肌肌皮瓣的解剖学基础及临床应用效果。方法在对斜方肌肌皮瓣的显微外科解剖学研究及跨越中线区皮瓣血供研究的基础上,应用超长下斜方肌肌皮瓣21例、超宽超长下斜方肌肌皮瓣6例,修复因各种外伤原因或肿瘤切除后致颅颌面大面积组织缺损22例,重度颌颈瘢痕粘连5例。结果临床应用27例,皮瓣最大面积42 cm×11 cm,最宽达15 cm,除3例超长下斜方肌肌皮瓣远端2~4 cm表皮糜烂经换药愈合外,余皮瓣均完全成活,术后经3~12个月随访,效果满意。结论下斜方肌肌皮瓣血运可靠,手术切取简便安全,皮瓣蒂较长,旋转弧度大,转移后远端可以到达颅顶甚至前额,超宽皮瓣覆盖范围更大,是一期修复颅顶和颈前大面积组织缺损较好的方法。     

颈阔肌肌皮瓣局部转移术的临床应用研究

目的：研究颈阔肌肌皮瓣移位术整复口腔组织缺损的应用解剖、分类,移位术方法及整复效果。方法：2005年4月～2010年9月,采用颈阔肌肌皮瓣修复口腔内舌、颊、下颌,口底部肿瘤切除后软组织缺损19例（男11例,女8例）,年龄36～80岁,平均46岁。颊粘膜癌6例,舌癌5例,下颌牙龈癌5例,口底癌3例。口腔颊部、舌部、下颌,口底区原发病灶切除后组织缺损范围：长5.0～6.0cm,宽4.5～6.5cm。采用病灶同侧颈阔肌皮瓣切取,行组织移位转入口腔内修复软组织缺损。皮瓣切取范围：长9.5cm,宽4.5cm。结果：经用这种组织瓣移位术方法完成的19例皮瓣手术后成活良好,皮瓣收缩不明显,口腔组织创面、张口度、舌运动度等口腔功能恢复良好。放疗后皮瓣维持原形态,无坏死、无萎缩。随访显示皮瓣长期愈合良好,无萎缩,适应口腔环境,皮肤组织粘膜化。供瓣区存在瘢痕,部分患者存在轻度影响头、颈部运动。结论：颈阔肌肌皮瓣血供明确、解剖恒定;邻近口腔组织缺损部位;皮瓣质地、范围适合口腔缺损整复,移位术后皮瓣成活稳定。     

Cutaneous trunci myocutaneous flap: a new and reliable model for muscle free flap research in the rat.

This paper deals with the first myocutaneous flap in the rat. It is located just caudal to the axilla and consists of the insertion of the cutaneous trunci muscle with overlying subcuticular fat and skin and is supplied by the lateral thoracic vessels. It exhibits an all-or-none survival pattern. Because the skin can serve as a marker for muscle viability, we believe that this flap has great potential in future free muscle research.     

上斜方肌皮瓣骨肌皮瓣的解剖和修复口腔颌面部缺损的临床应用

目的 观察上斜方肌皮瓣、骨肌皮瓣的血供和探讨修复颌面部缺损临床应用的可行性。方法 用32例成人颈部标本,对上斜方肌皮瓣、骨肌皮瓣的营养血管、行径、分支分布等进行解剖观察,并设计上斜方肌皮瓣、骨肌皮瓣,采用带蒂的方式应用于临床共18例,其中修复颊部缺损8例,舌再造3例,修复口底缺损4例,修复下颌骨缺损3例。结果 上斜方肌和肩胛冈是由颈横动脉分出的颈浅动脉升支和肩胛冈支营养。临床应用除1例皮瓣面积过大有少许皮肤坏死外,所有皮瓣均成活良好,修复效果满意。结论 该皮瓣具有血管解剖位置恒定,血供丰富,皮瓣面积大,手术方便,易成活等优点,适合于颌面部组织缺损的修复。     

同指背侧转移皮瓣的临床应用

目的 介绍一种指端离断后以瓣转移重建指端的方法。方法 应用同指远侧指间关节背侧转移皮瓣修复指端离断26例28指。结果 随访3－16个月，所有皮瓣均成活，伤指残端都有指甲生长，远侧指间关节活动范围满意。结论 同指远侧指间关节背侧转移皮瓣是修复指离断的一种较好的方法，具有操作简单，手术速度快，创伤小，效果好等优点。     

逆行肱桡肌皮瓣的解剖与临床应用

目的介绍逆行肱桡肌肌皮瓣修复前臂远端及腕部软组织缺损的手术方法。方法通过对2 0侧新鲜成人尸体上肢标本的应用解剖学研究,观测到肱桡肌有三组供血系统,由近及远分别为桡侧副动脉、桡侧返动脉及桡动脉发出的肌支,各营养血管又在肌内形成丰富的吻合。设计以桡动脉发出肱桡肌肌支为蒂的逆行肱桡肌肌皮瓣;临床应用8例修复前臂远端或腕部软组织缺损,皮瓣面积为15cm×8cm～8cm×6cm。结果8例肌皮瓣全部成活,皮瓣外形、质地满意。供区肘关节功能正常。结论以桡动脉肌支为蒂设计的逆行肱桡肌皮瓣,对修复前臂远端或腕部软组织缺损是一种较为简便易行的手术方法。     

对小腿逆行筋膜蒂皮瓣手术方法的改良和应用

目的 对小腿逆行筋膜蒂皮瓣手术方法进行系统归纳、总结，进一步提高疗效。方法 总结近年小腿逆行筋膜蒂皮瓣46例，对手术方法进行改良，使这一手术方法更加完善。结果 46例皮瓣全部成活，术后经平均随访1半年，效果满意。结论 小腿逆行筋膜蒂皮瓣是修复小腿胫前、踝、足跟部皮肤缺损理想的方法之一，通过手术方法的改良，使皮瓣成活率进一步提高。     

游离皮瓣与肌皮瓣修复小腿及足部大面积软组织缺损

目的：探讨游离皮瓣与肌皮瓣修复小腿及足部大面积皮肤软组织缺损的可行性。方法：应用游离背阔肌肌皮瓣，肩胛皮瓣，胸脐皮瓣三种方法修复小腿及足部大面积皮肤软组织缺损21例，分析其可行性与优点。结果：皮瓣全部成活，一期愈合18例，延期愈合3例。随访1～2年，皮瓣、肌皮瓣色泽正常，质地柔软。皮瓣臃肿6例，其余外观良好。行走及负重功能以及供区无明显功能受限。结论：应用游离皮瓣与肌皮瓣修复小腿及足部大面积皮肤软组织缺损具有修复面积大，能充分利用受区“废置”的血管以及抗感染能力强，促进早期功能锻练，质地好，一期能完全修复等优点。     

肌皮瓣在修复前胸壁慢性放射性溃疡中的应用

乳腺癌根治术后辅助放射治疗是预防癌肿复发的重要治疗措施之一。但由于根治手术破坏了前胸壁正常结构和放射线具有的致伤特性，被射线照射的区域易发生放射性损伤甚至溃疡。此类溃疡虽经换药和游离植皮却常常经久难愈。我们对２１例乳癌根治术后放疗引起的前胸壁慢性放射性溃疡病人，采用病灶切除后分别应用背阔肌皮瓣、胸大肌皮瓣和腹直肌皮瓣转移修复创面，治疗效果良好，１９例创面Ⅰ期愈合，２例创面Ⅱ期愈合。应用带血运的肌皮瓣转移修复创面解决了前胸壁区因根治手术或放射线所致的血管损伤而引起的创面难愈问题。对于肌皮瓣的选择，如胸背血管情况良好者首选背阔肌皮瓣，如该血管被原手术或放射线损伤，应改用胸大肌皮瓣或腹直肌皮瓣     

The use of tissue expansion to elongate the latissimus dorsi myocutaneous flap in the pig model

The latissimus dorsi myocutaneous pedicled flap is a reliable and versatile flap frequently used in reconstructive procedures. However, due to its fixed axial length, the use of this flap is limited to coverage of adjacent defects. In this study we present the use tissue expansion as a means to elongate the latissimus dorsi myocutaneous pedicled flap for coverage at distal sites in the pig model.     

外用前列腺素E1治疗缺血皮瓣的实验研究与临床观察

目的观察外用不同浓度前列腺素E1(PGE1)治疗皮瓣血液循环障碍的疗效. 方法于30只兔背部两侧各制作1条超长比例皮瓣(长6.0 cm、宽2.5 cm).配制质量浓度0.2%、0.4%、0.8%的PGE1乳膏涂抹于皮瓣表面,依次分为A、B、C 3个用药组,每组10条皮瓣.以实验兔自身对侧皮瓣涂抹无PGE1的基础乳膏为对照组,共30条.于用药前、用药后5、10、15、20、30、45、60 min观测皮瓣的血液灌流情况.用药后2 h取皮瓣组织标本,染色后行病理学观察并镜下测量皮瓣内微血管管腔横截面积.于术后3 d测定皮瓣的成活面积,计算其相对成活长度.在此基础上,对7例临床上可能出现坏死的皮瓣外用0.4%PGE1乳膏,观察皮瓣的转归.结果动物实验中可见A、B、C组用药后皮瓣的血流灌注单位明显升高,普遍于用药后30～60 min达到高峰,分别为(8.4±0.5)、(9.1±0.9)、(15.6±1.9)Pu.与对照组(6.1±0.7)～(6.2±0.8)Pu比较,差异有显著性意义(P<0.05);显微镜下见A、B、C组皮瓣内微血管明显扩张;术后A、B组实验兔的皮瓣成活面积和相对成活长度较其他组明显升高(P<0.01).7例患者用药后皮瓣远端全部成活. 结论外用0.2%、0.4%的PGE1软膏可明显改善皮瓣的血液灌流,促进皮瓣成活.     

Pectoralis myocutaneous flap for replacement of cervical esophagus

The authors report experience with 10 cases of pharyngoesophageal replacement with tubed pectoralis major myocutaneous (PM) flap. Six patients had primary reconstruction following total pharyngolaryngectomy for cancer; the other 4 had severe pharyngoesophageal stenosis requiring resection and replacement following previous laryngectomy. Seven of the patients were octogenarians, 6 had been irradiated previously, and all were severely debilitated. Two patients died postoperatively of cardiac disease. The remaining eight regained satisfactory with lasting deglutition. Four fistulae healed spontaneously, and one postoperative stenosis responded to a single dilitation. The interval to swallowing was 10-21 days in nonirradiated patients and 3-13 weeks in irradiated patients. There was one local recurrence 6 months after resection; the other patients remained free of disease. The authors conclude that the tubed PM flap is a reliable technique for pharyngoesophageal reconstruction that is particularly useful in elderly and debilitated patients.