皮瓣和肌皮瓣在食管外科中的应用

食管切除后常用胃或结肠来进行重建，但对于一些病变位置过高、合并胃或结肠病变、胃或结肠已做过手术、局限性严重食管狭窄患者，可选择其他方法重建或修复。能用于修复及重建食管皮瓣、肌皮瓣有十余种，根据血供来源分为游离皮瓣及带蒂肌皮瓣。游离皮瓣需血管吻合，一旦出现血管阻塞，易发生皮瓣坏死，以选择带蒂肌皮瓣修复及重建食管为宜。胸大肌皮瓣及背阔肌皮瓣尽管血运丰富，但肌皮瓣臃肿，且难以形成管状重建全周食管。颈阔肌皮瓣面积大，多源性血液供应，单侧可用于修复颈段食管缺损，双侧能重建全周颈段食管，手术操作简便，疗效可靠，长期随访皮瓣无溃疡及毛发生长，且能耐受放疗，值得推广应用。

Applicability of skin flaps and myocutaneous flaps for esophageal surgery

Stomach and colon are always used to reconstruct esophagus after esophagectomy. However, alternative procedures to reconstruct or repair esophagus are required if the patients suffered from gastric or colonic diseases, underwent gastric colonic operations or had severe local esophageal stricture. More than ten kinds of skin flaps and myocutaneous flaps, which are classified into free or pedicled ones, are used to reconstruct or repair esophagus. Microvascular anastomosis is required while using free flaps.Necrosis of the free flaps is prone to developing once the vascular occlusion occurs. The pectoralis major myocutaneous and latissimus dorsi pedicled flaps have sufficient blood supplies. However, both are bulky and difficult to reconstruct a circumferential esophagus through contouring a tube. Platysma myocutaneous flaps have a large surface area and are supplied from multiple vessels. Single lateral and bilateral platysma myocutaenous flap can be applied to repair the cervical esophageal defect and circumferential cervical esophagus, respectively. The use of platysma myocutaneous to repair and reconstruct cervical esophagus is a procedure easy to perform and confer excellent outcomes. There is no development of ulcer and hair growth after long-term follow-up and resistance to radiotherapy.