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。     

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。     

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。     

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.     

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.     

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.     

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.     

Extensive resection reconstruction using pectoralis major myocutaneous flap

A case of extensive resection of an oral—oropharyngeal tumour and the reconstruction using pectoralis major myocutaneous flap is described.     

The use of myocutaneous pectoralis major flap in reconstruction of the head and neck

The surgical treatment of advanced carcinomas of the head and neck often requires extensive resections, recessitating large flaps for neconstruction. In recent years, there has been wide appreciation of immediate repairs following the removal of large tumours, using the various myocutaneous flaps. The present paper discusses the use of pectoralis major myocutaneous flap in 16 of such patients.     

A novel technique of raising a pectoralis major myocutaneous flap through the skin paddle incision alone

A good reconstruction should not only be functionally and aesthetically sound at the recipient site but also cause least possible cosmetic aberration of the donor site. The pectoralis major myocutaneous (PMMC) flap continues to be one of the most commonly used flap for head and neck reconstruction in this part of the world. Conventionally, once the skin paddle over the pectoralis major muscle is marked, a line is drawn joining the outer edge of the skin flap extending to the apex of the anterior axillary skin fold or midclavicular point to expose the underlying pectoralis major muscle and harvest the flap. We intend to suggest a novel technique, in which the pectoralis major muscle is exposed by raising the skin around the skin paddle incision alone without making any further extension.     

Indications du lambeau du grand pectoral en carcinologie cervicofaciale: à propos de 37 cas au CHU de Dakar

Introduction: The use of pectoralis major myocutaneous flap in head and neck oncology allowed the excision of large tumors

Materials and methods

It is a retrospective study which concerns a period of 13 years in the course of which, 37 pectoralis major myocutaneous flaps were performed at the private hospital of ENT of Dakar.

Results

The mean age of our patients was 51 years with a sex ratio of 5.16. To the clinical plan, the pharyngo-laryngeal tumors prevailed in 64.87% of cases. The cancers of larynx expanding into the skin and requiring a square laryngectomy were our main indication (37.86%). It was followed by the surgical cure of pharyngostoma (18.92%). To the anatomical plan, we obtained a healing of first intention in more than half of our patients (54.05%).

Conclusion

Thanks to its qualities, the pectoralis major myocutaneous flap has already supplanted the other flaps and it finds its main use in the reconstruction after square laryngectomy.     

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。     

A combination therapy for hypopharyngeal cancer

A combination of induction chemotherapy, radical surgery with primary reconstruction of the cervical esophagus and postoperative chemo-radiotherapy has been utilized in our department for the treatment of hypopharyngeal cancer since January, 1983. Until then, preoperative chemoradiotherapy up to 4600 rads had been the policy of choice and satisfactory effect was not always obtained patho-histologically , though remarkable reduction of tumor was observed in many cases macroscopically. Radical surgery such as total laryngopharyngectomy with bilateral neck dissection followed by primary reconstruction using the pectoralis major myocutaneous flap is the procedure of choice. The myocutaneous flap is the procedure of choice. The myocutaneous flap technique is advisable in most cases, facilitating earlier use of post-operative chemoradiotherapy. Induction chemotherapy currently used in our department consists of sequential use of FT-207, ADR, MMC, Pepleomycin and then MMC again (FAM-PM).     

胸大肌肌皮瓣在喉癌手术中的应用

The experiences in reconstruction of surgical defects by pectoralis major myocutaneous flap after extensive cancer resection in 12 patients with advanced laryngeal carcinoma or recurrences are reported. The defects of different sites were reconstructed in one stage operation successfully. By this method, surgical indication is extended, therefore, reducing the patients' suffering and prolonging the survival. The preparation of the flap is described.     

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     

The Importance of Flaps in Reconstruction of Locoregionally Advanced Lateral Skull-base Cancer Defects: a Tertiary Otorhinolaryngology Referral Centre Experience

BackgroundThe aim of the study was to identify the value of extensive resection and reconstruction with flaps in the treatment of locoregionally advanced lateral skull-base cancer.Patients and methodsThe retrospective case review of patients with lateral skull-base cancer treated surgically with curative intent between 2011 and 2019 at a tertiary otorhinolaryngology referral centre was made.ResultsTwelve patients with locoregionally advanced cancer were analysed. Lateral temporal bone resection was performed in nine (75.0%), partial parotidectomy in six (50.0%), total parotidectomy in one (8.3%), ipsilateral selective neck dissection in eight (66.7%) and ipsilateral modified radical neck dissection in one patient (8.3%). The defect was reconstructed with anterolateral thigh free flap, radial forearm free flap or pectoralis major myocutaneous flap in two patients (17.0%) each. Mean overall survival was 3.1 years (SD = 2.5) and cancer-free survival rate 100%. At the data collection cut-off, 83% of analysed patients and 100% of patients with flap reconstruction were alive.ConclusionsFavourable local control in lateral skull-base cancer, which mainly involves temporal bone is achieved with an extensive locoregional resection followed by free or regional flap reconstruction. Universal cancer registry should be considered in centres treating this rare disease to alleviate analysis and multicentric research.Key words: temporal bone, microsurgery, parotid region, free tissue flaps, neoplasm staging, ear     

Chest radiograph appearances after head and neck flap reconstructive surgery

The chest radiographs of 17 patients who had undergone pectoralis major myocutaneous flap (PMMF) reconstruction for head and neck cancers were reviewed. Surgical procedure correlated well with radiographic findings, which consisted of the following signs: abnormal axillary and supraclavicular folds, replacement of normal vertical neck fold by an oblique fold, soft tissue mass and loss of facial plane at base of the neck. Unilateral radiolucent hemithorax was present in 41% of cases. In females, loss of breast shadow simulating the post-mastectomy appearance was present.     

多种组织瓣在口颊缺损重建中的应用

背景与目的：合理采用组织瓣进行口颊缺损重建,可以扩大口颊癌手术指征,改善患者的生存质量,延长患者生命。本研究目的是探讨组织瓣重建口颊缺损的指征,不同组织瓣的选择以及重建的手术技巧。方法：2005年9月至2007年8月间共行26例组织瓣重建口颊缺损手术,其中单纯口颊粘膜切除8例;口颊大型缺损18例,其中包括口颊面部皮肤洞穿切除11例,口颊、皮肤以及口角全缺损切除7例。26例患者中有7例行腮腺导管切除。胸大肌肌皮瓣转移重建5例,游离前臂桡侧皮瓣重建11例,游离股前外侧皮瓣6例,胸锁乳突肌肌皮瓣4例。8例患者行术后放疗,剂量为66～70Gy。结果：围术期无死亡病例,1例皮瓣坏死,为游离前臂皮瓣重建病例;1例皮瓣部分坏死,为胸大肌肌皮瓣重建病例。皮瓣成功率为96．2％（25／26）。1例伤口积液,为涎腺瘘。所有患者均随访1-3年,7例复发患者中4例为原发灶复发,3例为颈部淋巴结复发。随访期间2例患者死亡,均为原发灶局部复发者。结论：游离股前外侧皮瓣和游离前臂皮瓣是重建口颊大型缺损的良好皮瓣,是大于4cm的口颊缺损的首选：胸大肌肌皮瓣可作为口颊大型缺损重建的备用皮瓣;小于4cm的口颊缺损可选用胸锁乳突肌肌皮瓣。     

A long-term follow-up of pectoralis osteomyocutaneous flaps.

Reconstruction of the arch of the mandible has always been a difficult problem. The problem of reconstruction is compounded by bony defect and also the loss of soft tissue after resection of tumors of the floor of the mouth. A variety of different methods have been utilized for immediate and delayed reconstruction of the arch of the mandible with limited success. There are various post-operative complications and problems related to infection, soft tissue loss, and recurrence of the tumor. A free microvascular reconstruction is considered the best and the state of the art. However, it requires specialized training and expertise in microvascular surgery. Other methods have been successful, such as the pectoralis myocutaneous flap, pectoralis osteomyocutaneous flap, K wire, Steinman pin, and trapezius osteomyocutaneous flap. We have utilized the pectoralis osteomyocutaneous flap in six instances. Two of these patients have been followed for a long time, ranging from 7-8 years and we have noticed certain changes in the soft tissue and the rib. We are reporting here the long term results of the two patients who are alive from 7-8 years. The major finding in these patients was rib resorption and deteriorating cosmetic appearance and development of "Andy Gump" deformity.     

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.