以颈横动脉供血的延长锁骨上岛状皮瓣修复头颈部恶性肿瘤术后缺损

应用于头颈部缺损修复的皮瓣多种多样,包括局部皮瓣、带蒂皮瓣和游离组织瓣。其中带蒂皮瓣具有容易切取、颜色及质地较好、手术时间短、并发症少等优点而被广泛应用。锁骨上区是一个重要的皮瓣供区,肩部皮肤提供了理想的可修复头颈外科缺损的皮肤组织。颈侧三角区主要的锁骨上血管是颈横动脉,目前罕有以颈横动脉供血的延长至肩部皮肤的锁骨上岛状皮瓣修复头颈部恶性肿瘤术后缺损的报道。本文对此方面内容作一评价。     

面动脉瓣修复口咽癌术后缺损

目的探讨面动脉瓣修复口咽癌术后缺损的效果及临床应用。 方法选择2008年5月至2014年1月中山大学孙逸仙纪念医院口腔颌面外科收治的口咽癌患者33例,行肿瘤扩大切除术同期采用顺行或逆行面动脉瓣修复组织缺损。 结果33例面动脉瓣中,逆行性皮瓣11例全部成活,而顺行性皮瓣成活18例、部分坏死2例、完全坏死2例。皮瓣成活病例伤口愈合良好,患者术后语音和吞咽功能得到恢复。 结论应用面动脉岛状肌皮瓣修复口咽癌切除术后缺损,制取技术简单,皮瓣血供明确,皮瓣成活率高,瘢痕较为隐蔽,是修复口咽癌切除术后缺损的理想皮瓣。     

锁骨上动脉岛状瓣的应用解剖

目的:为临床应用锁骨上动脉岛状瓣提供解剖学依据。方法:在10例20侧经锁骨下动脉灌注氧化铅-明胶溶液的成人尸体标本上,对颈横动脉和锁骨上动脉的分支情况、起始位置、行程、长度和管径进行观测,观察其回流静脉情况,并在尸体标本上模拟皮瓣制备。结果:颈横动脉由甲状颈干或锁骨下动脉分支而来,在锁骨中1/3上方分为深支和浅支。锁骨上动脉由颈横动脉浅支发出后行向后外,越过斜方肌浅面和锁骨的肩峰端,走行于三角肌筋膜的浅面,并逐渐发出细小分支穿过深筋膜,进入锁骨上和肩部的皮肤和皮下组织。颈横动脉起点至锁骨上动脉起点距离平均为(4.31±0.64)cm,锁骨上动脉起点至其发出分支穿深筋膜点的距离平均为(3.62±0.42)cm。颈横动脉起点处外径平均为(2.71±0.33)mm,锁骨上动脉起点处外径平均为(1.10±0.17)mm。2条锁骨上动脉伴行静脉分别回流入颈横静脉和颈外静脉。结论:以锁骨上动脉为营养血管的锁骨上动脉岛状瓣,适于转移修复口腔颌面颈部组织缺损,也可以颈横动脉为吻合血管,制作游离皮瓣。     

锁骨上动脉岛状瓣在头颈部修复重建中的应用

因肿瘤切除引起的头颈部软组织缺损或畸形,常采用各种带蒂或游离组织瓣移植,恢复其外形和功能。锁骨上动脉岛状瓣因具有皮瓣质地和颜色与头颈部相近、厚度适中、制备简便和供区并发症少等优点,近年来日益受到人们的关注。该文对锁骨上动脉岛状瓣的历史、应用解剖、组织瓣设计和制备及其在头颈重建外科中的应用作一综述。     

延长垂直下斜方肌岛状肌皮瓣修复重建大型头颈部缺损

颈横动脉供血的延长垂直下斜方肌岛状肌皮瓣(extended vertical lower trapezius island myocutaneous flap,eVLTIMF)用于修复重建大型头颈部缺损安全可靠。该瓣制备较简单,成活率高。供区较隐蔽,可直接关闭缝合,并发症少,肩部运动受影响较小;还可制备成折叠瓣,合并其他带蒂瓣或合并肩胛骨骨肌皮瓣修复特大洞穿性缺损或下颌骨缺损。eVLTIMF在头颈部大面积缺损修复,尤其是在晚期复发性头颈部肿瘤挽救手术后巨大缺损修复重建中起着重要作用。本文对斜方肌的临床应用解剖、 eVLTIMF瓣制备及其在颅颌面、口腔颌面和颌颈区缺损修复中的应用作一阐述。     

折叠延长下斜方肌岛状皮瓣修复全喉切除术后巨大咽皮瘘8例报道

目的:探讨应用折叠延长下斜方肌岛状皮瓣修复全喉切除术后巨大咽皮瘘的临床效果。方法:8例（男7例,女1例;年龄46~65岁,平均年龄57.6岁）全喉切除术后巨大咽皮瘘患者,咽皮瘘直径2.0 cm×1.8 cm~4.5 cm×3.0 cm,采用折叠延长下斜方肌岛状皮瓣修复。皮岛宽5~9 cm,长10~23 cm,折叠修复咽皮瘘,恢复咽腔内衬里及外侧皮肤。结果:8例皮瓣全部成活,患者无继发咽皮瘘与咽狭窄,吞咽功能满意。结论:折叠延长下斜方肌岛状肌皮瓣可作为修复全喉切除术后巨大咽皮瘘的首选皮瓣,其操作简便,安全可靠。     

头颈部缺损重建术后持续性口底瘘或口咽瘘的救治性治疗

目的:探讨对持续性难治性口底瘘或口咽瘘的患者,运用清创+皮瓣修复的方法进行治疗的效果及预后影响因素.方法:回顾性分析上海交通大学医学院附属第九人民医院2009年1月—2018年12月因持续性口咽瘘和口底瘘,而进行二期或三期清创及皮瓣修复重建的患者.总结瘘管发生的可能原因,修复重建的方法,相关并发症及随访结果,并对预后影...     

颈横动脉为蒂的带蒂组织瓣在头颈肿瘤术后缺损修复中的应用

自上世纪70年代末以来,随着对颈横动脉及周围解剖研究的不断深入,颈横动脉为蒂的带蒂组织瓣修复头颈肿瘤术后缺损的手术方法和技巧的不断改进,以颈横动脉为蒂的带蒂组织瓣逐渐受到学者们的重视。笔者对目前国内外颈横动脉解剖学研究最新进展和以颈横动脉为蒂的带蒂组织瓣修复头颈肿瘤术后软硬组织缺损的临床研究作一综述。     

晚期口腔癌术后颊部大范围洞穿性缺损的修复

目的:评价延长锁骨上岛状筋膜皮瓣联合延长垂直下斜方肌岛状肌皮瓣修复晚期口腔癌术后颊部大范围洞穿性缺损的可行性。方法:对我院2008年6月—2012年2月施行的17例延长锁骨上岛状筋膜皮瓣联合延长垂直下斜方肌岛状肌皮瓣修复晚期口腔癌切除后颊部黏膜和皮肤巨大洞穿性缺损病例进行回顾分析。结果:17例患者均伴晚期口腔癌切除后的颊部软硬组织巨大洞穿性缺损,修复口腔衬里的延长锁骨上岛状筋膜皮瓣大小为10 cm×8 cm～14 cm×10 cm,修复外部缺损的延长垂直下斜方肌岛状肌皮瓣大小为15 cm×8 cm～25 cm×10 cm。所有病例均无严重并发症,随访6～34个月,9例患者无瘤生存,2例带瘤生存,6例死于局部复发及远处转移。结论:应用延长锁骨上岛状筋膜皮瓣复合延长垂直下斜方肌岛状肌皮瓣修复晚期口腔癌术后颊部大范围洞穿性缺损是一种可靠的修复方法,对于再次手术,以及放疗后病例,在一定程度上优于游离皮瓣等其他修复方法。     

Reconstruction of through-and-through oral cavity defects with folded extended vertical lower trapezius island myocutaneous flap

Reconstruction of through-and-through defects of the head and neck is a challenge. In this clinical study we assessed the feasibility of the folded, extended, vertical, lower trapezius island myocutaneous flap (TIMF) for the reconstruction of 16 large through-and-through defects of the oral cavity, which were reconstructed after resection of oral cancer. The skin paddle was 5–7 cm wide and 11–20 cm long. The folded flap provides both inner and outer linings for through-and-through defects, and all the flaps survived. The appearance of the head and neck was acceptable, and oral function was satisfactory. The folded extended vertical lower TIMF is a large, simple, and reliable flap that is preferred for the reconstruction of large through-and-through defects after resection of oral carcinoma.     

Indications for reconstruction of mucosal defects in oropharyngeal cancer using a supraclavicular island flap

The use of the supraclavicular island flap (SCIF) for the reconstruction of facial and neck skin defects is increasing. The value of this fasciocutaneous flap as a reconstructive modality for oropharyngeal defects in cancer patients is unclear. In the present study, a SCIF was used for reconstruction of mucosal defects following resection of the tumour in a group of four patients with T2 squamous cell carcinoma of the oropharynx and a clinical N0 neck. Reconstruction was performed following transoral tumour resection and selective neck dissection at levels I–III in the same session. Intraoperative and postoperative complications were analyzed, and functional and aesthetic results for the neck and shoulder region were evaluated in follow-up examinations. In addition, sensation to the flap was evaluated. No flap failures were observed. Only minor surgical complications were evident, which did not cause any relevant functional or aesthetic impairments. Sensation to the flap was observed in all cases. The SCIF appears to be a good and time-saving alternative to free flaps for oropharyngeal reconstruction following oncological resection in selected patients.     

Use of a folded extended vertical lower trapezius island myocutaneous flap to repair large pharyngocutaneous fistulae developing after salvage total laryngectomy

The purpose of this study was to evaluate the outcomes of surgery involving the use of folded trapezius flaps to repair large pharyngocutaneous fistulae (PCFs) developing after salvage total laryngectomy. Folded extended vertical lower trapezius island myocutaneous flaps (TIMFs) were created to repair large PCFs that developed after salvage total laryngectomy in eight patients. The maximum fistula dimension was 4.5 × 3.0 cm and the minimum was 2.0 × 1.8 cm. The skin paddle of the extended vertical TIMF ranged from 5 cm to 9 cm in width and 10 cm to 23 cm in length. The inner lining ranged from 3 cm × 3 cm to 6 cm × 6 cm in dimension and the outer lining from 6 cm × 5 cm to 16 cm × 9 cm. The folded flaps provided both inner mucosa and outer lining. All flaps survived. No fistula recurrence or stricture developed. After 6–24 months of follow-up, six patients showed no evidence of disease, one was alive with disease, and one had died of local recurrence at 20 months. The folded flap was very reliable and is well-suited for repairing large PCFs, even early large PCFs and those featuring carotid artery rupture.     

锁骨上动脉岛状皮瓣修复舌鳞癌术后缺损的临床研究

目的：探讨锁骨上动脉岛状皮瓣修复舌鳞癌术后缺损的临床效果。方法对12例行锁骨上动脉岛状皮瓣修复的舌鳞癌术后缺损患者进行回顾性分析,并对其术后外形及语音、吞咽功能恢复情况进行评估。结果12例术后行锁骨上动脉岛状皮瓣即刻修复舌鳞癌患者,11例皮瓣完全成活,1例皮瓣部分坏死,经短期换药后愈合,供区伤口均一期愈合,无明显的术后并发症,患者术区外形及功能均恢复满意。结论锁骨上动脉岛状皮瓣具有手术制取简单,供区并发症小,厚薄适中等优点,为舌鳞癌患者术后缺损的修复提供了一个新的选择。