头颈部岛状肌皮瓣和皮瓣的改良设计及临床应用

目的　探讨制作单一血管为蒂的头颈部局部带蒂肌皮瓣或皮瓣的安全性。方法　解剖学观察20例胸肩峰动脉分支，观察最远入肌点走行特征。通过术前超声观察和术中透视法观察定位最远入肌点，在最远入肌点上方1～2 cm断离肌肉，形成单纯动静脉血管为蒂的胸大肌岛状肌肌皮瓣。利用同样的技术方法，设计岛状的胸锁乳突肌、下位斜方肌的岛状肌皮瓣。结果　解剖学观察胸肩峰动脉分支分为单支型12.5%（5/40），双支型67.5%（27/40），多支型20%（8/40）。术前超声定位胸大肌皮瓣的最远入肌点成功率为29.1%（14/48），DSA成功显影乳内动脉穿支66.7%（12/18），共完成胸大肌岛状肌皮瓣48例，乳内动脉岛状皮瓣12例，颏瓣18例，下位斜方肌岛状肌皮瓣4例，胸锁乳突肌岛状肌皮瓣4例，颈横血管岛状皮瓣3例，胸肩峰动脉穿支的岛状皮瓣3例。失败2例，1例为胸大肌肌皮瓣的岛状设计中电刀误伤胸肩峰动脉胸肌支；1例为颈横血管浅支，术中修复扁桃体癌咽侧壁缺损。3例胸大肌部分坏死，清理完坏死组织，换药后痊愈。结论　在头颈部设计单一血管为蒂的岛状肌皮瓣（皮瓣）的改良设计安全可行，在受区皮瓣容易塑形固定，供区不仅外形美观且功能保全。

Modified design and clinical application of head and neck island muscle flap and flap

ABSTRACT]OBJECTIVETo investigate the safety of the head and neck muscle pedicle flap or flaps with single vascular pedicle.METHODSThe characteristics of thoracoacromial artery were investigated in 20 autopsy cases. Farthest point into the muscle were checked by preoperative ultrasonography and intraoperative localization with perspective observation, the muscles 1-2 cm above the farthest point were cut off from the donor site, forming a simple arteriovenous island flap pedicled pectoralis major muscle. Using the same technology and methods, sternocleidomastoid island and lower trapezius island flap were harvested.RESULTSAnatomical observation revealed thoracoacromial artery single type accounts for 12.5% (5/40), double vessel type 67.5% (27/40), multiple vessel type 20% (8/40). The rate of furthest point localization with preoperative ultrasound was 29.1% (14/48), the DSA successfully developed breast artery perforator in 66.7% (12/18) of the cases. Forty eight pectoralis major island muscle flaps, 12 internal mammary artery flaps, 18 chin flaps, 4 lower trapezius island myocutaneous flaps, 4 sternocleidomastoid island myocutaneous flaps, 3 transverse cervical artery island shaped flaps, 3 thoracoacromial artery perforator island flaps were harvested. Two flaps were failure. Partial necrosis occurred in 3 pectoralis major myocutaneous flaps.CONCLUSIONThe design of single vascular pedicle island flap for the head and neck defects is feasible and safe, and patients benefite not only for easily shaped the island flap, but also for the region appearance and function preservation in both the donor site and recipient site.