胸大肌肌皮瓣在晚期头颈肿瘤手术中的应用

目的探讨胸大肌肌皮瓣在晚期头颈肿瘤手术中的应用。方法应用胸大肌肌皮瓣一期修复晚期头颈肿瘤术后缺损262例（其中折叠瓣17例修复口内外穿通性缺损,20例胸大肌肌膜瓣修复口内缺损,5例胸大肌皮瓣联合游离植皮修复咽瘘,5例胸大肌肌皮瓣联合游离皮瓣双瓣修复颌面部洞穿性缺损）。舌再造62例,修复口咽53例,修复口底41例,修复口颊24例,修复颈部31例,修复下咽缺损22例,修复腮腺区缺损29例。结果262例肌皮瓣252例全部成活,8例皮瓣部分坏死肌瓣成活,2例肌皮瓣完全坏死,总的成活率为99.2%（260/262）。术后随访1～10年,所有患者术后进食、吞咽功能恢复良好,语言功能大多恢复良好。结论胸大肌肌皮瓣血供可靠,组织量丰富,且应用较灵活,可制作成肌皮瓣或肌瓣,对于晚期头颈肿瘤术后缺损是最优选择。     

头颈肿瘤术后组织缺损的修复(附46例报告)

目的　探讨头颈肿瘤术后组织缺损所需各肌皮瓣的设计、制备、转移和预防肌皮瓣坏死的措施。方法　分析我院 1989年 1月～ 2 0 0 1年 12月应用头颈部局部肌皮瓣、额部带血管蒂皮瓣、胸锁乳突肌肌皮瓣、唇瓣修复头颈肿瘤术后组织缺损 46例效果。结果　术后肌皮瓣存活良好 ,外观与周围组织色泽相似 ,外观及丰满度满意度为 93.5 % ,功能满意度为 91.3%。结论　修复头颈部缺损所需肌皮瓣要邻近取材 ,以缺定需 ,适中取瓣 ,保证血供 ,保护功能 ,注意肤色 ,修复丰满     

头颈肿瘤术后组织缺损的修复（附46例报告）

目的 探讨头颈肿瘤术后组织缺损所需各肌皮瓣的设计、制备、转移和预防肌皮瓣坏死的措施。方法 分析我院1989年1月-2001年12月应用头颈部局部肌皮瓣、额部带血管蒂皮瓣、胸锁乳突肌肌皮瓣、唇瓣修复头颈肿瘤术后组织缺损46例效果；结果 术后肌皮瓣存活良好，外观与周围组织色泽相似，外观及丰满度满意度为93．5％，功能满意度为91．3％：结论 修复头颈部缺损所需肌皮瓣要邻近取树，以缺定需，适中取瓣，保证血供，保护功能，注意肤色，修复丰满。     

供区免植皮的游离前臂皮瓣技术在头颈肿瘤修复中的运用

目的：介绍一种头颈肿瘤手术中游离前臂皮瓣供区时采用邻近双叶瓣替代游离植皮的技术。方法：在制备游离前臂皮瓣同期取前臂皮瓣缺损区域的临近尺侧双叶瓣修复缺损,避免前臂皮瓣供区植皮。双叶瓣大叶用于修复前臂皮瓣的供区缺损,其面积为前臂皮瓣供区缺损的80%。小叶用于修复大叶,其面积为大叶的50%。结果：全部13例前臂皮瓣成活,无皮瓣坏死,头颈部缺损均获得I期关闭和愈合。前臂供区均采用I期临近双叶瓣修复,两例患者出现瘀斑和水泡,经处理后均未影响双叶皮瓣的存活。所有患者前臂肘关节及腕关节运动正常,无受限。结论：改良的供区不植皮的前臂皮瓣制备技术减少了术后和供区并发症的发生,临近双叶皮瓣的运用避免了植皮带来的外形及功能影响,值得在头颈肿瘤前臂皮瓣修复中应用推广。     

胸大肌岛状皮瓣修复头颈部肿瘤术后组织缺损354例

目的：探讨头颈部较晚期恶性肿瘤彻底切除后大面积组织缺损应用胸大肌岛状皮瓣修复及功能重建。方法：应用胸大肌皮瓣修复头颈20余处不同的部位组织缺损。结果：354例重建中，35l例成功：3例皮瓣坏死(肌蒂成活)，皮瓣部分坏死9l例，皮下感染77例，咽瘘12例，17l例皮瓣无坏死及感染。la生存率90．7％，3a生存率45．4％，5a生存率40．7％，l0a生存率31．8％，15a生存率20％。结论：胸大肌岛状肌皮瓣能够解决头颈部较晚期恶性肿瘤术后大面积组织缺损的修复和功能重建。     

游离组织瓣移植修复头颈肿瘤术后复杂缺损

目的:探讨游离组织瓣在修复头颈部肿瘤术后复杂缺损中的应用. 方法: 对采用游离组织瓣同期修复头颈肿瘤术后复杂缺损34例资料进行分析.结果: 34例患者中,2例出现血管危象,1例皮瓣部分坏死,11例出现早期局部并发症,随访3月-2年,平均17个月,23例术后头颈部外形及功能基本恢复正常,受区和供区均无严重并发症;3例带瘤生存;7例分别死于局部复发、颈淋巴结转移及远处转移. 结论: 利用吻合血管的游离组织瓣,能同时提供足够的组织量及多个创面的覆盖,可修复各种头颈部肿瘤术后的复杂缺损.     

134例头颈部肿瘤手术后缺损修复

目的：分析4种皮瓣修复头颈部缺损的效果、功能、并发症和供区创伤的大小，以为不同的缺损选择不同的皮瓣。方法：134例头颈部肿瘤患者，均行联合根治术加胸大肌肌皮瓣、颈阔肌肌皮瓣、额瓣、前臂皮瓣修复。结果：胸大肌皮瓣全部存活96例，部分坏死21例，坏死≥1／25例，全部坏死2例，颈阔肌皮瓣全部存活2例，部分坏死1例，全部坏死1例，4例额瓣和2例前臂皮瓣全部存活。结论：口腔及颈部大面积缺损需要胸大肌肌皮瓣修复，对需要洞穿修复的，尤其是女性，应尽量避免用胸大肌折叠瓣，可用复合瓣。对一般的口腔缺损用前臂皮瓣修复最为合适。     

带蒂胸大肌皮瓣在头颈外科修复中的应用

目的：探讨带蒂胸大肌复合组织瓣在头颈肿瘤切除后组织缺损一期修复的方法及适应证,方法：采用带蒂胸大肌岛状复合组织瓣一期修复口腔癌7例,口咽癌,腮腺癌各1例,结果：9例均获满意的外观和功能,2例皮瓣部分坏死,均经换药痊愈。结论：带蒂胸大肌皮瓣可以满足颌面中部以下,口腔,颈部覆盖组织及衬里大面积缺损的修复,修复瓣成活率相对较高。     

头颈部恶性肿瘤术后缺损的Ⅰ期修复与重建

目的：探讨不同修复方法在头颈部恶性肿瘤术后缺损Ⅰ期修复与重建中的作用。评价其临床效果。方法：1989年1月至1998年12月，我们对258例头颈部恶性肿瘤患者的术后缺损进行了Ⅰ期修复与重建，患者年龄23-81岁，中位年龄51.3岁，男160例，女98例，缺损部位包括；头皮62例，颈部40例，口颊部39例，鼻部29例，唇颏部27例，颧颞部22例，下颌骨20例舌及口底部12例，其它7例，修复方法：局部皮瓣修复75例；局部皮瓣加游离植皮53例，邻近组织瓣修复加游离植皮47例，肌皮瓣18例，肌皮瓣加局部皮瓣或游离植皮25例；游离组织瓣移植30例，游离组织瓣加邻近组织瓣修复3例；组织代用品7例。结果：全组258例病人，共采用276个皮瓣及组织代用品修复，手术成功224例，手术基本成功23例，手术失败11例。结论：头颈部肿瘤术后Ⅰ期修复与重建可最大限度地减少术后功能障碍和畸形，提高患者生存质量。     

胸大肌岛状皮瓣在头颈部恶性肿瘤术后修复中的应用

目的介绍头颈部较晚期恶性肿瘤彻底切除后大面积组织缺损胸大肌岛状皮瓣修复及功能重建的应用。方法自1985年5月-2006年5月,应用胸大肌岛状皮瓣修复头颈20余处的部位组织缺损。结果408例重建中,405例成功,3例皮瓣坏死,（肌蒂成活）,皮瓣部分坏死63例,皮下感染112例,咽瘘15例,218例皮瓣无坏死及感染。结论胸大肌岛状皮瓣能够解决头颈部较晚期恶性肿瘤术后大面积组织缺损的修复和功能重建。     

带蒂胸大肌肌皮瓣移植在头颈癌放疗后手术中的运用

目的:探讨头颈癌放疗后因肿瘤复发进行挽救性手术,带蒂胸大肌肌皮瓣修复手术切除后软组织缺损的可行性和价值。方法:7例头颈部恶性肿瘤进行了根治性放疗后局部复发或颈淋巴结转移,通过手术切除病灶,颈淋巴结清扫,同侧带蒂胸大肌肌皮瓣移植修复软组织缺损创面。结果:7例移植的带蒂胸大肌肌皮瓣全部成活,有2例出现切口裂开,愈合困难。结论:在头颈癌放疗后手术中,带蒂胸大肌肌皮瓣移植是修复手术切除后软组织缺损的有效方法。     

胸大肌肌皮瓣在头颈部肿瘤术后组织缺损修复中的应用

目的 总结胸大肌肌皮瓣在头颈部肿瘤术后组织缺损修复中的应用。方法 1992年10月至2001年12月，对80例头颈肿瘤患者应用81块胸大肌肌皮瓣进行一期组织修复。结果 全组肌皮瓣完全存活71块。2块肌皮瓣皮肤完全坏死。8块肌皮瓣皮肤远端轻度坏死。结论 胸大肌肌皮瓣血供可靠，修复操作简单，用途广泛，能满足头颈部肿瘤术后缺损的修复。     

胸大肌肌皮瓣在晚期头颈肿瘤术后组织缺损重建中的应用

背景与目的:晚期头颈肿瘤外科治疗时,留下的完全或者不完全的组织缺损,是目前头颈外科的一个难点。胸大肌肌皮瓣在头颈肿瘤术后组织缺损重建中仍起着不可替代的作用。本研究旨在探讨胸大肌肌皮瓣在头颈缺损重建中的适应指征,提高胸大肌肌皮瓣修复的成功率。方法:中山大学肿瘤防治中心2004年1月至2007年1月间共22例行胸大肌肌皮瓣重建头颈肿瘤术后缺损患者,其中颈部大面积皮肤缺损8例,口咽缺损4例,舌缺损5例,口底缺损3例,下咽缺损2例;13例患者采用血管蒂穿行锁骨下,9例经锁骨上转移至颈部;重建的最大面积为15cm×12cm,最小面积为8cm×5cm。结果:无手术死亡病例,1例出现皮瓣坏死,1例出现部分皮瓣坏死,皮瓣重建成功率为95.5%;手术后并发症伤口积血1例,口底瘘1例,并发症发生率为9.1%(2/22)。结论:胸大肌肌皮瓣是头颈肿瘤术后组织缺损重建的良好供区皮瓣,是颈部大面积皮肤缺损重建的首选皮瓣;血管蒂穿行锁骨下可以增加胸大肌肌皮瓣的修复半径,且有利于保护血管蒂不受压迫。     

The indications and complications of pectoralis major myocutaneous flap reconstruction in head and neck surgery-our experience

Most of the head and neck cancer patients in India present to the Otolaryngologist, Head and Neck surgeon in the advanced stages of their disease. Extensive resection followed by acceptable morphological & functional reconstruction is the goal for the surgeon. Use of the pectoralis major myocutaneous (PMMC) flap enables extensive ablative procedures to be carried out followed by immediate and reliable reconstruction. Thirty consecutive cases of biopsy proven squamous cell carcinoma of the head and neck region were studied. All underwent extensive resection of the tumour with pectoralis major myocutaneous flap reconstruction, with preor post-operative external irradiation. This study concentrates on the indications for and complications encountered with the use of the pectoralis major myocutaneous flap. Also included is an extensive review of the literature relating to the complications encountered with the use of this method of reconstruction.     

Metastatic spread of floor of the mouth squamous cell carcinoma via pectoralis major myocutaneous flap

In a patient with recurrent head and neck squamous cell carcinoma, reconstruction of the floor of the mouth was carried out by transposition of a pectoralis major myocutaneous flap after composite resection. Twelve months after surgery, a chest wall metastasis corresponding to the site of the vascular pedicle was observed. It appears that the lymphatic and hematogenous tumor spread can occur along the vascular pathways of a transposed myocutaneous flap.     

Planned multidisciplinary approach in the treatment of advanced carcinoma of the tongue

16 patients with advanced lingual carcinoma treated by planned multidisciplinary treatment and postoperative reconstruction in our hospital from 1970 to 1984 are reported. The treatment included: preoperative chemotherapy of high dose MTX; extensive resection of the tongue with radical neck dissection and postoperative radiation. The immediate reconstruction was performed by using pedicled major pectoralis myocutaneous flap in 12 patients and free tensor fascia lata myocutaneous flap in 4. The 5 and 3 year survival rates of stage IV lesions were 50% and 100%. The advantages of the planned multidisciplinary treatment of advanced lingual cancer are discussed.     

Large, deep high-grade extremity sarcomas: when is a myocutaneous flap reconstruction necessary?

The surgical treatment of large, deep high-grade extremity soft tissue sarcomas frequently produces a significant tissue defect. In addition, the management of the surgical wound is often further complicated by preoperative radiation or adjuvant therapies. The use of either pedicled or free myocutaneous flaps allows for more rapid and predictable wound healing in this situation. Myocutaneous flaps provide well-vascularized coverage of lost tissue volume, exposed vital structures, and prosthetic reconstruction materials. When harvested from unirradiated sites, flap coverage can overcome the detrimental effects of radiation therapy and chemotherapy on postoperative wound healing. Reconstruction of the soft tissue defect may also improve patient satisfaction with aesthetic issues. The use of innervated myocutaneous flaps can even address the functionality of the extremity following resection of major muscle groups. Myocutaneous flaps are an extremely versatile option for reconstruction in the treatment of large, deep high-grade extremity soft tissue sarcomas.     

The free vastus lateralis flap for reconstruction in ablative oncologic head and neck surgery.

AIMS: The vastus lateralis muscle is an accessory extensor for the knee suitable as a free myocutaneous flap in reconstructive head and neck surgery. We report the use of this muscle as a flap. METHODS: We have used the free myocutaneous vastus lateralis flap for reconstruction following ablative head and neck tumour surgery in six patients. The clinical outcome, time of surgery for flap preparation and anatomosis, follow-up and functional outcome were analysed. RESULTS: Five of our patients showed a very satisfactory functional and cosmetic outcome. Post-operatively, there was no prolonged immobilisation and no limitation of movement to the hip and knee. No unfavourable side-effects at the donor side were noted. CONCLUSIONS: We find this flap a very useful addition to our free myocutaneous flap armamentarium. It has a specific suitability for replacing large defects.