胸大肌肌皮瓣在晚期口腔颌面肿瘤术后修复中的应用

目的：探讨胸大肌肌皮瓣在晚期口腔颌面肿瘤术后缺损修复中的应用。方法：对66例口腔颌面部肿瘤术后应用胸大肌肌皮瓣进行一期修复病例进行总结分析。结果：胸大肌肌皮瓣皮肤完全坏死1例，皮肤远端部分坏死5例，完全成活率为90．9％。结论：胸大肌肌皮瓣血供丰富，成活率高，操作简单，是口腔颌面肿瘤术后缺损修复的理想材料。     

胸大肌肌皮瓣在晚期口腔颌面肿瘤术后修复中的应用

目的　探讨胸大肌肌皮瓣在晚期口腔颌面肿瘤术后缺损修复中的应用。方法　对 6 6例口腔颌面部肿瘤术后应用胸大肌肌皮瓣进行一期修复病例进行总结分析。结果　胸大肌肌皮瓣皮肤完全坏死 1例 ,皮肤远端部分坏死 5例 ,完全成活率为 90 9%。结论　胸大肌肌皮瓣血供丰富 ,成活率高 ,操作简单 ,是口腔颌面肿瘤术后缺损修复的理想材料     

胸大肌肌皮瓣Ⅰ期修复头颈部肿瘤术后缺损——附25例临床分析

对胸大肌肌皮瓣在 2 5例头颈部肿瘤术后缺损修复中应用的临床资料进行总结分析。 2 5例患者中 ,2例皮瓣出现不同程度的坏死 ,1例完全坏死 (占 12 % ) ,其他均完全成活。胸大肌肌皮瓣修复头颈部肿瘤术后缺损成活率高 ,可广泛应用于头颈部各个部位     

胸大肌肌皮瓣Ⅰ期修复头颈部肿瘤术后缺损—附25例临床分析

对胸大肌肌皮瓣在25例头颈中肿瘤术后缺损修复中应用的临床资料进行总结分析,25例患者中,2例皮瓣出现不同程度的坏死,1例完全坏死（占12％）,其他均完全成活,胸大肌肌皮瓣修复头颈部肿瘤术后缺损成活率高,可广泛应用于头颈部各个部位。     

胸大肌肌皮瓣在头颈部手术缺损修复中的应用

 目的 寻找一种头颈部大面积手术后缺损的修复手段。方法 回顾山西省肿瘤医院头颈科自1985年以来在头颈部大面积手术缺损后进行的胸大肌肌皮瓣修复患者77例。结果 77例胸大肌肌皮瓣修复中72例成活，其中边缘坏死2例，感染6例；全部坏死5例。近5年来成活率为100 ％（18／18）。结论 在头颈部肿瘤手术造成的大面积缺损病例中，胸大肌肌皮瓣是一种用途很广的重要修复手段。     

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。     

胸大肌肌皮瓣用于咽喉晚期肿瘤术后一期修复

[目的]探讨胸大肌肌皮瓣在咽喉晚期肿瘤术后一期修复中的应用价值.[方法]对1996年6月到2004年6月55例咽喉晚期肿瘤根治术后一期应用胸大肌肌皮瓣修复的资料进行分析总结.其中舌根癌19例、扁桃体癌10例、喉咽癌9例、喉癌9例、鼻咽癌8例.术前放疗21例,术后放疗25例.胸大肌肌皮瓣修复咽喉部黏膜及黏膜下软组织缺损40例,修复颈部皮肤缺损15例.[结果]55例胸大肌肌皮瓣均一期修复完成.1例肌皮瓣皮肤完全坏死失败,3例肌皮瓣远端皮肤少许坏死重新清创缝合,修复成功率为98.2%(54/55).40例修复咽喉部黏膜缺损病人有3例进食轻度呛咳,1例进食吞咽不畅外均恢复吞咽功能,除全喉切除病人外均基本恢复语言功能.15例修复颈部皮肤缺损病人切口均愈合.3、5年存活率舌根癌为4/8,2/5;扁桃体癌为3/6,2/4;喉咽癌为2/4,1/3;喉癌为2/3,1/2;鼻咽癌为2/4,1/3.[结论]胸大肌肌皮瓣血供可靠,组织容量大,在咽喉部晚期肿瘤手术中应用可以提高存活率及病人术后生存质量,成功率高,是一期修复的理想材料.     

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。     

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。     

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。     

改良带蒂胸大肌皮瓣修复头颈部晚期恶性肿瘤术后复杂缺损的临床应用

背景与目的：带蒂胸大肌皮瓣因为具有多种优点一直是头颈部组织缺损修复应用的经典组织瓣。当今,随着显微技术普及和提高,游离组织瓣逐步取代了带蒂组织瓣。然而,临床上并非所有病例均适宜接受游离组织瓣修复手术,邻近带蒂组织瓣更安全可靠。拟通过改进胸大肌皮瓣的制备及修复方法,探讨改良带蒂胸大肌皮瓣在修复头颈部晚期恶性肿瘤术后复杂缺损时的应用。方法：在皮瓣设计方案及制备方法等多方面改进胸大肌皮瓣,修复头颈部晚期恶性肿瘤术后复杂缺损患者51例。结果：51例改良胸大肌皮瓣全部存活,缺损区修复后外形和供区外形情况满意,缺损区功能得到良好的恢复,供区术后功能损伤最小化。结论：胸大肌皮瓣在设计及制备方法等多方面的改良,提高了对头颈部恶性肿瘤术后复杂缺损修复的范围及修复的距离,减少皮瓣坏死的概率,术后供区和受区外形、功能效果满意,目前仍然是头颈部恶性肿瘤术后缺损的重要修复手段之一。     

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.     

头颈部肿瘤修复皮瓣对放疗的耐受性

目的:探讨吻合血管的游离皮瓣组织对局部放疗的耐受性及安全性。方法:选取我院2015年至2018年收治的经皮瓣修补术头颈恶性肿瘤患者11例，采用适形调强放疗（IMRT）或旋转调强放疗（VAMT）常规分割剂量进行放疗，放疗期间及放疗结束后通过复查喉镜、颈部增强CT或MR，观察移植皮瓣急性放射性反应情况。结果:放疗过程中皮瓣组织表现为色素沉着、干性脱皮，且伴有不同程度的充血水肿，与周围放疗野内组织床相仿，反应程度随着放疗剂量的增加而加重。放疗结束后11例患者移植皮瓣无1例出现皮瓣坏死。放疗3个月后复查喉镜、颈部增强CT或MR，咽喉腔内颈阔肌皮瓣愈合良好，无出血坏死，2例患者皮瓣区充血水肿消退。胸大肌皮瓣修复的颈部淋巴结转移患者中，皮瓣区色素沉着有所缓解，术痕区愈合良好，无干性脱皮。结论:颈阔肌皮瓣、胸大肌皮瓣对于临床常规剂量（<70 Gy）术后放疗具有良好的耐受性，相对安全可靠。     

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.     

Role of Pectoralis major flap in carotid artery protection

Rupture of the carotid artery is a disastrous complication in head and neck surgery and usually results from and interplay of rediotherapy, wound dehiscence and salivary contamination. Pectoralis major myocutaneous flap was utilised in three patients with an impending blowout and in three others with carotid rupture to promote revascularisation of the vessel wall, help seal salivary leak and obtain cutaneous tissues for closure of wound dehiscence. Following repair with pectoralis major myocutaneous flap no further vessel problems recurred in any patient.     

The pectoralis major myocutaneous flap in head and neck reconstruction

The pectoralis major myocutaneous flap (PMMC flap) represents a landmark in the development of head and neck reconstructive surgery. After Stephan Ariyan first described its use for head and neck reconstruction in 1979, it has become tremendously popular and has revolutionised head and neck cancer surgery. Here, we present our initial experience with fourteen PMMC flaps in head and neck reconstruction. In most of the instances it was used for oral or oropharyngeal reconstruction. It was used for five other reconstructive tasks as well. Wound infection was the most common complication. There was no case of total flap loss. It has proven to be a reliable method of reconstuction in the head and neck.     

The use of myocutaneous flap for reconstruction of surgical defects in the oropharyngeal area

Oncological Dispensary of Leningrad Region, St.Petersburg Our paper deals with evaluation of the results of using distal pectoralis major myocutaneous flap (38) in 37 patients; bilateral dissection of tissue--1. Plastic reconstruction of surgical effects of the oral cavity and pharynx was performed in 27 (skin cancer--8, parotid salivary gland tumor--1). Flap was used to both shield the parotid artery and prevent erosive bleeding following radical cervical dissection, urgent plastic surgery--30, postponed--8. Complication, chiefly slight was reported in 60.5% and treated conservatively. Total necrosis was identified in 2 (5.3%), partial--4 (10.8%), salivary fistula--10 out of 27 reconstructions of the upper intestinal tract (18.4%), cervical suture failure--7 (18.4%), flap avulsion from wound edges--6 (15.8%), wound edge avulsion--2 (5.3%). Nasogastric probe for feeding was used for approx. 23.7 days. Feeding per os after the first operation was restored in 23 (85.2%). Repeat reconstruction using pectoralis major myocutaneous flap has proved effective in patients with surgical effects of head and neck.