岛状胸锁乳突肌肌皮瓣在面颊部复合组织缺损修复中的应用

目的 探讨岛状胸锁乳突肌肌皮瓣在面颊部复合组织缺损尤其是面颊部洞穿性组织缺损修复中的应用.方法 以胸锁乳突肌上端为蒂部,蒂部包含枕动脉,以乳突尖下2 cm处为肌皮瓣旋转轴点,根据缺损部位及大小进行肌皮瓣设计,以该点至缺损区最远点为肌瓣的长度,肌瓣宽度以稍大于创面宽度即可,但最大宽度不宜超过7 cm,下界不超过锁骨下2 cm.沿设计线切开,切断胸锁乳突肌起点,在胸锁乳突肌下分离切取皮瓣.蒂部仅包含胸锁乳突肌而不带皮肤.肌皮瓣经蒂部与缺损之间皮下隧道转移至缺损区,逐层缝合切口.供区视缺损大小可行直接拉拢缝合或邻近皮瓣转移或植皮修复.结果 应用岛状胸锁乳突肌肌皮瓣转移修复面颊部组织缺损12例,其中面颊部软组织肿瘤10例,颊部洞穿性缺损2例,术后肌皮瓣全部成活,被修复处色泽、厚度及外形均尚满意.结论 岛状胸锁乳突肌肌皮瓣血供丰富,血管恒定,切取及转移方便,是修复面颊部较大面积复合组织缺损的理想肌皮瓣.

Island sternocleidomastoid myocutaneous flap for repairing the buccal composite tissue defect

Objective To study the application of island sternocleidomastoid myocutaneous flap in repairing the buccal composite tissue defect especially penestrated tissue defect. Methods The flap pedicle included upper part of sternecleidomastoid muscle and occipital artery. The rotation point was locate at 2 cm below the mastoid. The distance between the pivot point and distal border of the defect was the length of the muscular flap. The width of the flap was slightly larger than the defect, but should not be more than 7 cm. The lower border of the flap should not exceed 2 cm below the collarbone. The flap was elevated from the starting point of the sternocleidomastoid muscle and beneath it. The pedicle only contained muscle. The flap was transferred to the defect through the tunnel between the pedicle and defect. The wounds at donor sites were closed directly or with skin graft or local flaps. Results 12 cases were treated, including 10 cases of buccal soft tissue tumors and 2 cases of buccal penestratod defects. All the musculocutaneous flaps survived with good texture, color and thickness. Conclusions The island sternocleidomastoid myocutaneous flap is an ideal flap for large buccal composite tissue defect with reliable blood supply. It is easily performed and very practical.