胸大肌肌皮瓣在晚期头颈肿瘤术后组织缺损重建中的应用

背景与目的:晚期头颈肿瘤外科治疗时,留下的完全或者不完全的组织缺损,是目前头颈外科的一个难点。胸大肌肌皮瓣在头颈肿瘤术后组织缺损重建中仍起着不可替代的作用。本研究旨在探讨胸大肌肌皮瓣在头颈缺损重建中的适应指征,提高胸大肌肌皮瓣修复的成功率。方法:中山大学肿瘤防治中心2004年1月至2007年1月间共22例行胸大肌肌皮瓣重建头颈肿瘤术后缺损患者,其中颈部大面积皮肤缺损8例,口咽缺损4例,舌缺损5例,口底缺损3例,下咽缺损2例;13例患者采用血管蒂穿行锁骨下,9例经锁骨上转移至颈部;重建的最大面积为15cm×12cm,最小面积为8cm×5cm。结果:无手术死亡病例,1例出现皮瓣坏死,1例出现部分皮瓣坏死,皮瓣重建成功率为95.5%;手术后并发症伤口积血1例,口底瘘1例,并发症发生率为9.1%(2/22)。结论:胸大肌肌皮瓣是头颈肿瘤术后组织缺损重建的良好供区皮瓣,是颈部大面积皮肤缺损重建的首选皮瓣;血管蒂穿行锁骨下可以增加胸大肌肌皮瓣的修复半径,且有利于保护血管蒂不受压迫。

Reconstruction with pectoralis major myocutaneous flap for surgical defect in advanced head and neck cancer patients

BACKGROUND & OBJECTIVE: Total or partial defects after one-stage reconstruction for advanced head and neck cancer is a challenging problem in head and neck surgery. Pectoralis major myocutaneous flap (PMMF) plays an irreplaceable role in head and neck reconstruction surgery. This study was to define operational indications for using PMMF in head and neck defect reconstruction, and summarize how to further increase the success rate. METHODS: From Jan. 2004 to Jan. 2007, 22 patients who underwent head and neck defect reconstruction using PMMF were investigated. Of the 22 patients, 8 had cervical skin defect, 5 had tongue defect, 4 had oropharynx defect, 3 had base of tongue defect, and 2 had hypopharynx defect; 13 had the flap passed through the subclavicular tunnel to the head and neck area, and 9 had the flap transposed over clavicle to the neck. The reconstruction size ranged from 15 cm x 12 cm to 8 cm x 5 cm. RESULTS: No patient died during operation, 1 had total flap necrosis, and 1 had partial flap necrosis. The success rate of reconstruction was 95.5%. Postoperative complications occurred in 2 (9.1%) patients: 1 had wound hematocele, and 1 had fistula at the base of the tongue. CONCLUSIONS: PMMF is a good donor for head and neck reconstruction, especially for resurfacing huge cervical skin defect. The approach of passing the vascular pedicle through a subclavicular tunnel will not only enhance the arc of rotation, but also help to prevent compression of the vascular pedicle.