改良胸大肌岛状肌皮瓣在颌面部缺损修复重建中的应用

目的 探讨改良的胸大肌岛状肌皮瓣在颌面部软组织缺损修复中,延长血管蒂及改善皮瓣血运的可行性.方法 自2002年至2009年,对11例颌面部软组织缺损创面,应用改良的胸大肌岛状肌皮瓣进行修复.术中通过彻底松解血管蒂(胸肩峰动脉胸肌支),完全断开蒂部肌肉组织,将血管蒂从锁骨后骨膜下穿过,以增加血管蒂长度.切取皮瓣远端时携带部分腹直肌前鞘,并保留肋间血管的穿支与胸肩峰动脉胸肌支远端的吻合血管,以改善皮瓣远端的血运.结果 11例患者获随访2～36个月,胸大肌岛状肌皮瓣未发生坏死或部分坏死.2例患者术后发生腮腺漏,1例发生口腔内霉菌感染,1例发生轻度睑外翻.结论 改良的胸大肌岛状肌皮瓣在修复颌面部软组织缺损中可以延长血管蒂,增加转移范围,并具有改善皮瓣远端血运的优点.     

胸大肌肌皮瓣在口腔颌面部缺损修复中的应用

报道２１９例口腔颌面部肿瘤，其中良性肿瘤１８例，恶性肿瘤２０１例，在肿瘤切除后，均采用胸大肌肌皮瓣修复缺损。采用单皮岛肌皮瓣２０１例，双皮岛肌皮瓣１６例，肌皮骨瓣２例。成功２０１例，失败１８例。讨论了胸大肌皮瓣的优点及适用范围。介绍了手术设计、操作方法。分析了成功与失败的影响因素，认为正确，精细的手术技巧是成功的关键因素。     

胸大肌皮瓣在头颈外科修复中的并发症

回顾10年来228例（232块皮瓣）胸大肌皮瓣移植术，总结了该皮瓣在头颈外科修复中的并发症，有皮瓣坏死、感染、血肿、瘘、伤口裂开等。皮瓣全部坏死率1．7％，感染率27．6％。分析危险因素与年龄超过70岁、女性患者、过量吸烟、口腔及口咽修复、手术时间超过7小时，术前放疗量超过70Gy，严重营养不良，伴发期它系统性疾病有关。发生并发症者，平均住院时间64天，无并发症者仅31天。     

胸大肌肌皮瓣移位修复面颌颈胸部难治性创面

面颌颈及胸部各种原因所致的深度创面，一期修复均较为困难。１９８９年１１月～１９９６年４月，采用胸大肌肌皮瓣或胸大肌岛状肌瓣移位修复１１例，其中肌皮瓣８例，肌瓣３例，面积１２ｃｍ×８ｃｍ～２６ｃｍ×１８ｃｍ。术后创面Ⅰ期愈合１０例，１例创面轻度感染，换药治愈。详细介绍了手术方法和手术要点，讨论了胸大肌肌皮瓣移位对此类创面修复的优越性。     

胸大肌皮瓣在晚期喉癌喉咽癌的应用

在12例晚期喉癌或喉咽癌的广泛切除后,应用胸大肌肌皮瓣或肌瓣修复术区缺损,成活率为92.3％。其中用于喉咽修复3例,颈前修复4例,颈侧修复5例。认为在完全切除癌瘤后,用胸大肌组织瓣可满意修复术后的广泛性缺损,能为晚期病例提供综合治疗的机会。     

口腔颌面部组织缺损应用胸大肌肌皮瓣修复的疗效观察

目的:观察应用胸大肌肌皮瓣修复口腔颌面部组织缺损的临床治疗效果。探讨口腔癌术后组织缺损采用胸大肌肌皮瓣修复的整体护理方法和效果。方法:系统回顾分析我科2005年6月～2011年6月我科24例口腔颌面部软组织损伤伴缺损患者和20例口腔癌术后口腔颌面部软组织缺损患者一期采用胸大肌肌皮瓣修复的临床资料。结果 :44例患者胸大肌肌皮瓣存活42例,存活率为95.45%,3例患者皮瓣出现部分坏死。患者无血管危象、感染、瘘管等并发症发生。术后随访1年,41例患者皮瓣平整,吞咽、进食、发音等功能恢复良好。结论:胸大肌肌皮瓣修复口腔颌面部组织缺损,具有组织量大、局部血运丰富、灵活性高、术后并发症少等优点,是修复口腔颌面部组织缺损、恢复完美外形和功能的理想方法。     

胸大肌皮瓣改良切取术临床比较

目的：通过改良的胸大肌肌皮瓣及蒂部经锁骨上或下隧道成功率之间的比较，验证两者与皮瓣成活率之间的关系，为推广蒂部经锁骨下隧道寻找依据。方法：对肌蒂经锁骨上或下隧道穿行共１００例进行临床对比研究，并提出改良的方法。结果：肌蒂经锁骨上或下隧道成活率分别为９４．７４％、９５．４０％；两组并发症经ｔ检验，Ｐ＞０．０５，两者差异无显著性。结论：经改良的胸大肌肌皮瓣切取法经锁骨下隧道通过是安全可行的，并有其优点，建议推广应用     

胸大肌皮瓣在颈部放射性溃疡修复中的应用

目的:总结胸大肌岛状肌皮瓣在颈部放射性溃疡创面中的应用效果。方法:1997年3月~2013年9月,对21例放射治疗导致的颈部溃疡创面的临床资料进行回顾性分析。16例应用同侧带蒂胸大肌肌皮瓣进行Ⅰ期修复,其中2例术中注射PRP至溃疡周围正常皮肤;5例Ⅱ期修复:先行伤口清创+VSD吸引,每日庆大霉素加重组人表皮生长因子溶液VSD冲洗创面,伤口明显改善后,再应用同侧带蒂胸大肌肌皮瓣进行修复。结果:18例胸大肌皮瓣成活良好;3例(Ⅰ期修复)皮瓣远端部分坏死,其中1例经换药后愈合,2例清创术后采用局部皮瓣修复后愈合。结论:胸大肌皮瓣血管蒂长,血运丰富,可修复创面面积大,易成活,采用VSD及PRP处理创面后,有助于胸大肌皮瓣在修复颈部放射性溃疡创面的愈合。     

The pectoralis major myocutaneous flap in head and neck reconstruction

Summary This paper discusses the pectoralis major myocutaneous flap, its anatomy, preparation, and dissection, for use in head and neck reconstruction. Illustrative cases are reviewed and the advantages of this flap presented.     

游离股前外侧皮瓣与改良胸大肌皮瓣在修复头颈肿瘤术后缺损中的选择与改进

目的探讨游离股前外侧皮瓣与改良胸大肌皮瓣在头颈肿瘤术后缺损修复中的应用及效果。方法2011年11月至2016年11月湖南省肿瘤医院头颈外科收治头颈部肿瘤患者394例,男性286例,女性108例,年龄25~79岁。分别采用游离股前外侧皮瓣(306例)、改良胸大肌皮瓣(88例)修复头颈肿瘤术后缺损。采用t检验法分析不同方法修复的效果及患者生存质量,总结2种皮瓣修复的优缺点及适应证。结果本组394例,游离股前外侧皮瓣组皮瓣成活率97.1%(297/306),改良胸大肌皮瓣组成活率97.7%(86/88);手术总时间2组相近,游离股前外侧皮瓣组3~4 h,改良胸大肌皮瓣组1.5~2.5 h;术后1年,UW-QOL评分游离股前外侧皮瓣组与胸大肌皮瓣组相比,在外观、言语功能及肩部运动方面有显著优势,差异有统计学意义(P<0.05)。结论头颈部肿瘤术后缺损修复中,游离股前外侧皮瓣及改良胸大肌皮瓣都具有较高的成功率,游离股前外侧皮瓣适用于复杂缺损的修复,改良胸大肌皮瓣对血管条件、全身状况不佳的患者,更具有安全性。     

Microvascular salvage of a failing pectoralis major myocutaneous flap

Summary While being elevated prior to reconstruction of a left-sided neck defect, a pectoralis major myocutaneous island flap was rendered ischemic by the inadvertant transection of the pectoral branch of the thoracoacromial artery. In order to save the flap, a microvascular repair between the distal end of this vessel and the ascending branch of the transverse cervical artery was performed. The flap was successfully revascularized and the patient went on to uneventful healing with 100% flap viability. This technique could be used following similar technical error in the elevation of any axial pattern flap providing that suitable vessels for repair were present.     

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.     

Complications of the pectoralis major osteomyocutaneous flap used for head and neck reconstruction

The analysis of the complications of the pectoralis major osteomyocutaneous flaps used for head and neck reconstruction and how to prevent them is the subject of this report. Ten patients with squamous cell carcinoma of the floor of the mouth who had undergone segmental glossectomy and mandibulectomy, radical uni- or bilateral cervical lymphadenectomy, and immediate reconstruction with the pectoralis major osteomyocutaneous flaps were evaluated. Neither partial nor total necrosis of the myocutaneous segment occurred in any patient but rib necrosis developed in five. An oral fistula occurred in four patients exposing the junction of the rib with the mandible. There were three cases of flap necrosis of the neck dissection. Two patients developed pneumothorax. The overall complication rate was 66.7%. Although this surgery requires major intraoral excision, the tumor is exophytic with previous infection and the patients' general condition debilitated, the incidence of complications is high. Despite the high morbidity, the pectoralis major myocutaneous flap remains a useful adjunct for head and neck reconstruction. The flap is versatile and for many patients repair with a free flap is impossible because of contraindications such as previous irradiation, problems with the vascular anastomoses, advanced age and poor general condition. It also aids in the surgical training of new specialists.     

A cross-over pectoralis myocutaneous flap

Summary A right pectoralis major myocutaneous flap was raised and crossed over the midline to cover an exposed clavicle. This again illustrates the versatility of the pectoralis myocutaneous flap.     

Salvage for pectoralis major myocutaneous flap failure in head and neck reconstruction by microvascular flap

Abstract

The pectoralis major myocutaneous pedicled flap (PMMPF) – the “workhorse” for head and neck reconstruction – is associated with a high incidence of complications in certain cases. This study presents free tissue transfer as an alternative salvage technique after PMMPF failure in head and neck reconstruction. It includes seven consecutive patients who underwent free tissue salvage after PMMPF failure in head and neck reconstruction from January 2008 to September 2010 at Kaohsiung Medical University Hospital, Taiwan. Four vertical rectus abdominis myocutaneous (VRAM) flaps were applied for tongue and mouth floor defects, while three anterolateral thigh (ALT) flaps were used for mouth floor, buccal, and cheek defects. All flaps survived uneventfully, and normal oral feeding was achieved without major complications. Free tissue transfer has several advantages and can be successfully employed in head and neck reconstruction, and it is also a reliable salvage procedure after PMMPF failure in such cases.     

Pharyngo-esophageal reconstruction by pectoralis major myocutaneous flaps

Summary The authors want to show that the island pectoralis major myocutaneous flap has proved to be now the most effective for immediate pharyngoesophageal and neck reconstruction as stated in three preliminary publications which were the first positive reports about this technique.     

胸大肌肌皮瓣脂肪液化的相关危险因素探讨

目的探讨胸大肌肌皮瓣术后发生脂肪液化的相关危险因素。方法对1998年5月至2005年12月采用胸大肌肌皮瓣修复口腔癌术后组织缺损的82例中10例术后发生不同程度脂肪液化的病例,进行Logistic回归分析。结果Logistic单因素回归分析结果表明：肥胖、电刀切开皮下组织、皮岛设计低于第7肋、吸烟等因素与胸大肌肌皮瓣术后发生脂肪液化有关;Logistic多因素回归分析结果表明：胸大肌肌皮瓣术后发生脂肪液化与肥胖、电刀切开皮下组织、皮岛设计低于第7肋等因素有关,而与吸烟无关。结论肥胖、电刀切开皮下组织、皮岛设计低于第7肋等因素是胸大肌肌皮瓣术后发生脂肪液化的危险因素。     

应用胸大肌岛状肌皮瓣重建全舌体、口底的初步报告

目的 探讨累及双侧的舌癌根治术后全舌体、口底重建的有效方法及临床评价。方法 对2000年10月至2002年12月问我科收治的7例累及双侧的舌癌患者实施根治性手术，造成全舌体、口底的大面积缺损，采用一侧胸大肌岛状肌皮瓣转移即时重建全舌体和双侧口底。结果 6例转移肌皮瓣完全成活，口腔和颈、胸部创面均一期愈合。1例肌皮瓣远端部分皮肤坏死，但无口底颌下瘘和感染等并发症发生。术后随访2～16个月，重建舌体、口底形态基本满意，语言功能大部分恢复，吞咽功能恢复良好。1例在术后9个月死于肿瘤肺转移，其余6例目前均继在。结论 胸大肌岛状肌皮瓣组织量大，血供丰富，是全舌体、口底重建的理想选择。