Radiation-induced vesico-vaginal fistula successfully repaired using a gracilis myocutaneous flap

Surgical repair of a radiation-induced vesico-vaginal fistula by a simple closure technique is extremely difficult. Here, we report a patient with a radiation-induced vesico-vaginal fistula that was successfully reconstructed using a gracilis myocutaneous flap. The vesico-vaginal fistula developed in an 83-year-old Japanese woman who had undergone a radical hysterectomy for cervical cancer of the uterus at age 63, and had pelvic radiation therapy for recurrent disease 17 years after the surgery. The fistula was repaired by a reconstruction technique that employed a gracilis myocutaneous flap. Two-thirds of the vaginal mucosa on the side where the fistula was present was completely removed to obtain a wide mucosal defect. Irradiated fibrous tissue around the fistula was removed, and the bladder mucosa was mobilized, and then closed with absorbable sutures. An island gracilis myocutaneous flap was designed on the medial aspect of the patient's left thigh. The first incision was made through the proximal outline of the flap, and its vascular pedicle, the medial circumflex femoral vessels, was dissected. After a complete incision through the flap, the skin flap, including the entire gracilis muscle, was elevated with the pedicle vessel. The distal portion of the myocutaneous flap was then turned to overlay the mucosal defects on the vagina. Postoperatively, there was no flap necrosis and no infection in the vaginal cavity. Indwelling catheterization was required for 8 weeks. Retrograde cystography confirmed complete closure of the fistula. Received: March 13, 2000 / Accepted: July 25, 2000     

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。     

男性外生殖器恶性肿瘤大块切除后缺损区的修复

目的 对局部晚期的男性外生殖器恶性肿瘤大块切除后缺损区的修复.方法 对本组11例患者行病灶广泛切除及淋巴结清扫后,运用筋膜皮瓣、腹直肌岛状肌皮瓣、臀大肌及阔筋膜张肌复合肌皮瓣进行缺损区修复,重点介绍了腹直肌岛状肌皮瓣的切除方法.结果 11例患者中10例患者修复区Ⅰ期愈合,1例延期愈合.结论 根据缺损程度选择合适的皮瓣是手术成功的关键.     

Reconstruction of full-thickness cheek defects after cancer surgery

The value of various surgical techniques used to reconstruct full-thickness cheek defects is discussed. Small defects can be repaired with the use of local cervical skin flaps with a random vascular pattern. Axial pattern temporal flap is another choice, either alone or combined with a cervical flap. Whenever local tissues are not suitable (i.e. after irradiation or neck dissection) a transfer of distant myocutaneous island flap based on a pedicle of axial muscle vessels is a valuable alternative. Split skin graft may form a good intra-oral lining of such island flap.     

翻转胸舌骨肌皮瓣气管重建实验研究

目的探讨翻转双蒂胸舌骨肌皮瓣及去表皮翻转双蒂胸舌骨肌皮瓣修补气管缺损后的转归。方法以18只兔作为实验对象，在气管前壁造全层圆形缺损，分别用翻转双蒂胸舌骨肌皮瓣(皮瓣组)及去表皮翻转双蒂胸舌骨肌皮瓣(去表皮组)修补，于术后2、4、8个月处死动物，用肉眼及组织学切片观察。结果8个月时皮瓣组移植物与气管交界处可见假复层纤毛柱状上皮从外周长入，但中央大部分仍为复层鳞状上皮，而去表皮组移植物表面全部被假复层纤毛柱状上皮覆盖。结论去表皮肌皮瓣修补气管缺损较肌皮瓣容易转变为气管黏膜上皮。     

Metastasis of malignant peripheral nerve sheath tumor to free vascularized myocutaneous flap

The vascularized free myocutaneous flap graft, a recent advance in microsurgery, is a very useful reconstruction technique for covering massive soft tissue defects or muscular dysfunction caused by wide resection for malignant soft tissue tumors. We have used this technique to treat many patients after resection for malignant soft tissue tumors. Recently we encountered a case in which a malignant peripheral nerve sheath tumor (MPNST) metastasized to a vascularized free myocutaneous flap used for limb reconstruction surgery after wide resection of a primary lesion. To our knowledge, there have been no previous reports of metastasis of a malignant soft tissue tumor (or any other cancer) to a grafted cutaneous or myocutaneous flap.     

Surgical delay of TRAM flaps for breast reconstruction.

The lower transverse rectus abdominis myocutaneous (TRAM) flap may give excellent results in breast reconstruction using autogenous tissues alone, however, surgical technique is demanding, and the risk of necrosis owing to vascular failure is high. We observed excellent vascularity of the flap in all 20 cases operated upon so far; in all these cases skin island was surgically delayed for one week before final transfer.     

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。     

Pectoralis major rib osteomyo cutaneous flap in primary mandibular reconstruction in floor of the mouth cancer

We report pectoralis major rib osteo myocutaneous flap in reconstruction of cancer floor of the mouth in 8 cases. We have discussed it's advantages in country like ours over the micro vascular graft. The rib (Vascularised bone graft) incorporated in this flap gives ideal support for mandibular arch reconstruction.     

胸锁乳突肌肌皮瓣修复口腔颌面部软组织缺损的临床应用

目的：探讨胸锁乳突肌肌皮瓣修复口腔颌面部软组织缺损的临床效果。方法：采用胸锁乳突肌肌皮瓣修复16例口腔癌患者术后所致软组织缺损。供区皮肤直接拉拢缝合。结果：术后切口均Ⅰ期愈合,16例胸大肌肌皮瓣全部成活,无1例发生全部或部分皮瓣坏死,移植成活率100%。患者获得满意的外观和功能。经过6个月-5年的随访,无1例肿瘤复发或远处转移。结论：胸锁乳突肌肌皮瓣制备较简单,效果可靠,具有很大的灵活性,且成活率高。可用于口腔颌面部软组织缺损的修复。     

舌骨下肌皮瓣修补口腔肿瘤术后缺损的临床观察

目的 观察舌骨下肌皮瓣修补口腔肿瘤术后缺损的临床效果及其合适的手术方式.方法 将行肌皮瓣修补口腔肿瘤术后缺损的38例患者随机分为观察组及对照组,各19例.观察组采用舌骨下肌皮瓣逆行法或顺行法进行修补,对照组采用其他部位肌皮瓣进行修补.比较2组患者皮瓣的完全成活率、总体成活率,术后3年、5年患者存活率及后期并发症发生率.比较观察组中2种手术方式的临床疗效.结果 观察组皮瓣完全成活率、总体成活率均明显高于对照组(P<0.05);观察组术后3年及5年患者存活率略高于对照组,但差异具无统计学意义(P>0.05).观察组后期并发症发生率明显低于对照组(P<0.05).观察组顺行法疗效明显优于逆行法(P<0.05).结论 舌骨下肌皮瓣应用于口腔肿瘤术后缺损的修补中疗效显著,其中顺行法修补疗效更为满意.     

横行下腹直肌肌皮瓣乳房再造术

目的　介绍乳腺癌根治术后乳房再造方法。方法　应用横行下腹直肌肌皮瓣 (TRAMflap)进行乳房再造。结果　应用该方法治疗 2 2例 ,再造乳房形态良好。结论　TRAM皮瓣乳房再造术对乳腺癌根治术后患者是一种安全有效的治疗方法     

Myocutaneous v/s micro vascular free flaps in oral cavity reconstruction - a comparative study

Micro vascular free tissue transfer scores over the traditional myocutaneous flaps by providing better cosmesis and function. However, the increased operating tine and costs and the necessity for two operating teams sometimes, negate these advantages and even where this facility is freely available, myoentancous flaps continue to be widely used. To determine the ideal choice of reconstruction in patients after oral resection, we compared our experience with these two methods of reconstruction. Since 1997, when we first started micro vascular reconstruction, 17 patients have undergone this procedure for oral reconstruction. During this same period, 40 patients had pectoralis major myocutaneous flap reconstruction of the oral cavity. These two groups are compared with regard to cosmetic and functional results (as measured by patient’s level of satisfaction) operating time, duration of hospitalization, cost and complications. Results: Eightv seven percent of the patients in the micro vascular group and 75% in the myocutaneous group were satisfied with the cosmetic and functional results. In the microvascular group, average operating time was increased by 4 hours; hospitalization by 3 days and average cost of treatment was doubled. Flap failures and re-explorations were significantly higher in the micro vascular group. Based on these results, we would like to suggest the ideal method of reconstruction of the oral cavity in specific subgroups of patients in a corporate hospital setting.     

Reconstruction of an extensive chest wall defect using an external oblique myocutaneous flap following resection of an advanced Breast carcinoma: Report or a case

We reconstructed a large chest wall defect, resulting from the resection of a locally advanced breast carcinoma, using an external oblique myocutaneous flap. The patient, a 58-year-old Japanese woman, presented with an inoperable breast carcinoma (Stage IV). Combination chemotherapy with cyclophosphamide (CPA) and epirubicin hydrochloride (EPI) resulted in a reduction in size of both the primary tumor and the metastatic lesions. However, the patient continued to experience purulent discharge accompanied by an unpleasant odor, as well as contact bleeding from the residual breast lesion. To address these complaints, we removed much of the remaining tumor surgically. The resulting skin defect measured 440 cm(2) and was covered using an external oblique myocutaneous flap. The patient's postoperative course was excellent, and she was still alive and well after 40 months of chemotherapy. This case is a demonstration of the effectiveness of the external oblique myocutaneous flap for the coverage of large ipsilateral chest wall defects.     

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。     

Cosmetic reconstruction after resection of breast cancer: use of the ELD-MC flap and EVRAM flap

Breast reconstruction following the resection of breast cancer with inadequate residual chest-wall tissue may be performed with an implant or a myocutaneous flap, such as the latissimus dorsi or a rectus abdominis. Among a variety of operative procedures, each method has advantages and disadvantages. The insertion of a silicone-bag prosthesis is the easiest method, but the prosthetic implant sometimes has complications, such as unfavorable capsular contracture formation around the implant, rupture, infection, or exposure. We therefore use an extended latissimus dorsi myocutaneous (ELD-MC) flap with some amount of surrounding subcutaneous fat from the lumbar area, and avoid the use of any implant with an MC flap. Also, for the reconstruction and correction of infraclavicular and axillary depression, we use the extended vertical rectus abdominis myocutaneous (EVRAM) flap. This method uses the skin and fat on both sides of the umbilicus as a lenticular flap vascularized by only one of the rectus abdominis muscles. The patients are satisfied with the outcome because symmetry and good breast volume can be obtained. There have been no functional or anatomical defects of the donor area. No abdominal hernia after an EVRAM flap has resulted to date. Both the ELD-MC and EVRAM flaps can be successfully used for cosmetic breast reconstruction after the resection of breast cancer.     

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.     

保留皮肤的乳腺癌改良根治术后即刻乳房再造的临床应用

目的探讨保留皮肤的乳腺癌改良根治术后即刻再造乳房的适应证、方法、效果及可行性。方法2002年1月至2007年11月本院对94例乳腺癌患者行保留乳房皮肤皮下乳腺组织切除加腋窝淋巴结清扫术后，应用下腹部横行腹直肌肌皮瓣（transverse rectus abdominis myocutaneous flap，TRAM）、背阔肌肌皮瓣（latissimus dorsi myocutaneous flap，LDM）联合或不联合假体、单纯乳房假体植入4种方式即刻再造乳房。结果再造手术均取得成功。带蒂TRAM再造47例，LDM再造共42例（其中联合假体28例），单纯乳房假体植入5例。4例出现轻微术后并发症（4．25％）。经过3～67个月随访，局部区域复发率为0，再造乳房形态自然，效果满意，术后外观评价优良率97．87％。结论合理选择病例行保留皮肤或保留乳头乳晕乳腺癌改良根治术后即刻乳房再造是安全可靠的，切口隐蔽并能够保留原有乳房皮肤的感觉，从而获得最佳美容效果，值得广泛推广和应用。     

颈部肌皮瓣喉再造发音重建术的探索

目的探讨颈部肌皮瓣喉再造术的方法和操作要点。方法2000年10月—2003年9月间对11例喉全切除术后患者行颈部肌皮瓣喉再造发音重建术。用颈部肌皮瓣连接下咽和气管，形成类似“会厌”和“声带”的结构，由此达到能发音、呼吸且无明显呛咳的目的。结果全部患者术后都较好的恢复了发音，且音量音质接近正常人，呛咳等并发症轻微。结论该手术操作较简单，效果确切，后遗症小，是一种较好的喉再造术式。